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Open Sciatic Nerve Decompression for Compartment Syndrome after Prolonged Lithotomy Position: A Case Report. | LitMetric

AI Article Synopsis

  • Position-related compressive nerve injuries can occur during prolonged surgeries in the lithotomy position, with compartment syndrome-induced neuropathy being a rare and often misdiagnosed complication.
  • A 56-year-old male patient experienced severe leg issues after a 16-hour surgery in this position, presenting with pain and limited movement in his left foot and toes.
  • After imaging confirmed nerve compression, surgical intervention to decompress the sciatic nerve led to immediate pain relief and significant improvement in motor function.

Article Abstract

Position-related compressive nerve injury is a frequently reported complication of the lithotomy position. In contrast, compartment syndrome-induced neuropathy after lithotomy with prolonged surgery is rare and prone to misdiagnosis. This case describes the successful open decompression of sciatic neuropathy due to compartment syndrome after a prolonged lithotomy position. A 56-year-old male patient complained of an abnormal sensation in the lower leg and difficulty in dorsiflexion and plantarflexion of the left foot and toes after laparoscopic anterior hepatic sectionectomy for 16 h in a lithotomy position. Physical examination revealed severe pain and paresthesia below the distal left thigh. In manual muscle test grading, dorsiflexion and plantarflexion of the left ankle and toes were classified as grade 1. Computed tomography and magnetic resonance imaging showed ischemic changes in the mid-thigh posterior muscles, and the sciatic nerve was severely swollen at the distal thigh, which was compressed by the proximal edge of the well-leg holder. After debridement of the necrotic tissue and decompression of the sciatic nerve, the pain subsided immediately, and the ankle and toe dorsiflexion motor function improved to grade 4. Most case reports of compressive neuropathy associated with the lithotomy position have been related to conservative treatment. However, if a lesion compressing the nerve is confirmed in an imaging study and the correlation with the patient's symptoms is evident, early surgical intervention can be an effective treatment method to minimize neurological deficits.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9612347PMC
http://dx.doi.org/10.3390/medicina58101497DOI Listing

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