Cases reported "Compartment Syndromes"

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1/20. Acute atraumatic compartment syndrome in the leg.

    The compartment syndrome is well recognised as occurring after trauma, but atraumatic acute compartment syndrome is less widely known. We report 3 cases in whom an acute compartment syndrome developed without major injury. early diagnosis and prompt treatment by decompressive fasciotomy is of vital importance if limb function is to be preserved and complications avoided.
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keywords = decompressive
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2/20. Abdominal compartment syndrome in patients with burns.

    Abdominal compartment syndrome (ACS) is a well-recognized perioperative complication that occurs in patients who undergo intra-abdominal operations and who require extensive fluid resuscitation. The classic presentation of this syndrome includes high peak airway pressures; oliguria, despite adequate filling pressures; and intra-abdominal pressures of more than 25 mm Hg. A decompressive laparotomy performed at the bedside can alleviate ACS. If left untreated, sustained intra-abdominal hypertension is often fatal. In the literature, ACS has been described in pediatric patients with burns but not in adult patients with burns. This article describes 3 adults who sustained burns of more than 70% of their body surface areas, who required more than 20 L of crystalloid resuscitation, and who developed ACS during their resuscitation after the burn injury. The mortality rate among these patients was 100%, which confirms the grave consequences of this syndrome. In our institution, intra-abdominal pressure is now routinely measured as part of the burn resuscitation process in an attempt to diagnose and treat this syndrome earlier and more efficaciously. It is recommended that the possibility of ACS be considered when diagnosing any patient with burns who develops high airway pressures, oliguria, or both.
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ranking = 1
keywords = decompressive
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3/20. An endoscopic technique for decompressive fasciotomy.

    A guiding principle of minimally invasive techniques in plastic surgery is improvement of the aesthetic outcome, usually by reducing morbidity from postsurgical scarring. The elimination or reduction of scars has already been so achieved during elevation of fascial flaps and for the harvest of fascial grafts. A natural extension of this endoscopic experience is decompressive fasciotomy, which has now been performed successfully in the upper extremity. Using endoscopic guidance, this is actually a simple, rapid, and safe procedure with minimal morbidity, and should also be apropos for the lower extremity, where compartment syndromes are a more common malady.
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ranking = 5
keywords = decompressive
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4/20. Acute compartment syndrome of the forearm in association with ulnar shortening osteotomy: a case report.

    A 41-year-old man experienced severe pain in the forearm after undergoing ulnar shortening osteotomy to treat positive ulnar variance, a complication of a fracture of the distal end of the radius. The patient had compartment syndrome with compartment pressure of 55 mm Hg. A decompressive fasciotomy of the volar compartment provided total relief of pain and, subsequently, full recovery of all functions. We report the case and discuss the serious nature of compartment syndrome, its associated complications, and methods of diagnosis and management.
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ranking = 1
keywords = decompressive
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5/20. The use of high positive end-expiratory pressure for respiratory failure in abdominal compartment syndrome.

    We report a case in which a non-trauma patient suffering hematemesis and undergoing massive volume resuscitation developed abdominal compartment syndrome (ACS). The abdominal distension severely compromised his pulmonary functioning: a chest radiograph showed low lung volumes and dense bilateral parenchymal opacities. His blood oxygen saturation reached as low as 32%. Because he was hemodynamically unstable and coagulopathic, decompressive surgery was not possible. We gradually raised the ventilator settings to reinflate the lungs (positive end-expiratory pressure [PEEP] was raised to 50 cm H(2)O, peak inspiratory pressure to 100 cm H(2)O, and plateau inspiratory pressure to 80 cm H(2)O) and continued fluid resuscitation, and within an hour his blood oxygen saturation increased to 100%. In this case high PEEP was beneficial in a situation in which decompressive surgery was not feasible, but we do not suggest that high PEEP necessarily improves survival or that high PEEP is better than surgical decompression. On the contrary, high-pressure ventilation can be harmful in the setting of acute lung injury and acute respiratory distress syndrome, so we do not advocate high PEEP for all patients with hypoxemia and ACS, especially considering that many of the conditions associated with ACS can also precipitate acute lung injury and acute respiratory distress syndrome. As well, high-pressure ventilation can increase the risk of hypotension by impairing venous return. However, our case suggests that high PEEP may temporize in certain situations in which ACS causes life-threatening hypoxia but surgical decompression is not possible.
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ranking = 2
keywords = decompressive
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6/20. Abdominal compartment syndrome after liver transplantation.

    The abdominal compartment syndrome is a well-known complication after abdominal trauma and is increasingly recognized as a potential risk factor for renal failure and mortality after adult orthotopic liver transplantation (OLT). We present a case report of a young patient who presented with acute liver failure complicated by an acute pancreatitis. The patient developed an acute abdominal compartment syndrome after OLT. Transurethral measurement of intraabdominal pressure indicated an abdominal compartment syndrome associated with impaired abdominal vascular perfusion, including liver perfusion. renal insufficiency was immediately reversed after decompressive bedside laparotomy. The abdominal compartment syndrome is a potential source of posttransplant renal insufficiency and liver necrosis in OLT. It remains, however, a rarely described complication after liver transplantation, despite the presence of significant factors that contribute to elevated intraabdominal pressure.
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ranking = 1
keywords = decompressive
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7/20. Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome.

    INTRODUCTION: Decompressive laparotomy for abdominal compartment syndrome has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction. This study investigates the role of plastic surgeons in the management and reconstruction of these abdominal wall defects. methods: We performed a retrospective review of 82 consecutive critically ill patients who underwent decompressive laparotomy for abdominal compartment syndrome, at a university level 1 trauma center, from April 2000 to May 2004. patients reconstructed by trauma surgeons alone (n = 15) were compared with patients reconstructed jointly with plastic surgeons (n = 12), using Student t test and chi analysis. RESULTS: Eighty-two patients underwent decompressive laparotomy for abdominal compartment syndrome, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair, and 21 had staged reconstruction with primary fascial closure (n = 4), components separation alone (n = 3), components separation with mesh (n = 10), or permanent mesh only (n = 4). Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (50.5 versus 31.7 years, P < 0.05), had more comorbidities (P < 0.001), were less likely to have a traumatic etiology (P < 0.001), had a longer delay to reconstruction (407 versus 119 days, P < 0.05), and were more likely to undergo components separation (P < 0.05). Mean follow-up of 11.5 months revealed 2 recurrent hernias in the combined reconstruction group, both of which were successfully repaired. CONCLUSIONS: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for abdominal compartment syndrome. Although carefully selected patients can undergo early primary fascial repair, most of reconstructed patients had staged closure of the abdominal wall via components separation, with a low rate of recurrent hernia. High-risk patients with large defects and comorbidities appear to benefit from the involvement of a plastic surgeon.
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ranking = 7
keywords = decompressive
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8/20. Use of a fascial prosthesis for management of abdominal compartment syndrome secondary to obstetric hemorrhage.

    BACKGROUND: Massive obstetric hemorrhage can be catastrophic, with considerable maternal morbidity and mortality. CASE: A 41-year-old term gravida experienced massive postpartum hemorrhage attributed to an amniotic fluid embolism with rapid development of disseminated intravascular coagulation and resultant abdominal compartment syndrome. In this critically ill patient, a fascial prosthesis used for abdominal wall closure was placed to expedite multiple abdominal explorations and packing. Additionally, this device facilitated fascial closure once the abdominal compartment syndrome was resolved. CONCLUSION: Abdominal compartment syndrome resulting from overwhelming obstetric hemorrhage may necessitate emergent decompressive laparotomy to alleviate increased intra-abdominal pressure and end-organ dysfunction. The fascial prosthesis allows a staged abdominal wall closure to be performed once the abdominal compartment syndrome is resolved.
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ranking = 1
keywords = decompressive
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9/20. Secondary abdominal compartment syndrome in children with burns and trauma: a potentially lethal complication.

    Acute, rapid, and unimpeded increases in intra-abdominal pressure can lead to multiple organ dysfunction defined as the abdominal compartment syndrome (ACS). If this develops in the absence of obvious intra-abdominal injury, it has been termed secondary ACS (2 degrees ACS). Massive fluid resuscitation in the presence of large burns or shock can lead to 2 degrees ACS. The importance of early recognition and the need for urgent abdominal decompression have been recognized in adults; however, this has not been appreciated in the pediatric population. medical records of four children diagnosed with 2 degrees ACS were reviewed. Secondary ACS occurred in three children with burns and in one child with a traumatic brain injury. Three children underwent decompressive laparotomy, and one underwent successful percutaneous drainage. There were two survivors. Secondary ACS may be observed in burnt or traumatized children needing large volume resuscitation. Early recognition of 2 degrees ACS by routine bladder pressure monitoring in this high-risk group of children may result in earlier decompression and a possible decrease in morbidity and mortality.
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ranking = 1
keywords = decompressive
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10/20. Acute volar compartment syndrome during skeletal traction in distal radius fracture. A case report.

    Fractures of the distal end of the radius rarely cause acute compartment syndrome of the forearm. Acute compartment syndrome of the forearm occurred after a fracture of the distal end of the radius in a 17-year-old boy who developed symptoms after application of skeletal traction. Satisfactory recovery was obtained by early decompressive fasciotomy. In this case a combination of traction and elevation of the forearm appeared to have increased the susceptibility of the limb to acute compartment syndrome.
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ranking = 1
keywords = decompressive
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