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PubMed2004

Chronic exertional compartment syndrome.

Chronic exertional compartment syndrome is an overuse condition affecting primarily active, athletic people. Its etiology is unclear, but several theories have been proposed. The syndrome is characterized by recurrent, often severe muscle compartment pain that occurs with vigorous exercise and subsides with rest. Physical examination usually provides little helpful information. Compartment pressure measurement before and after exercise is the mainstay of objective diagnosis. Conservative management has been highly unsuccessful. Overall, considerable success can be expected from fasciotomy of the involved compartments followed by a rigorous rehabilitation program, though recurrence of symptoms is a reported complication. Recent research efforts have focused on the development of less invasive and more accurate diagnostic modalities and safer and more effective surgical procedures.

Chronic Disease↗
PubMed1982

[Ischemic necrosis of the deep extensors of the forearm: a rare compartment syndrome].

The ischemic compartment syndrome is thought to develop following an unphysiological pressure increase in one of the numerous muscular compartments of the extremities, confined by bone surface and strong fascia. Pressure-induced ischemia may cause partial or total necrosis of the vulnerable structures in the compartment. This ischemic compression syndrome was found in the deep extensor compartment of the distal forearm in a young female patient following osteotomy of the ulna. The syndrome at this rather unusual site was not diagnosed and treated in the acute phase. Resection of fibrotic, contracted musculature (extensor indicis proprius, extensor pollicis longus and brevis and abductor pollicis longus) and tendon transfer were performed to restore useful function.

Adult↗
PubMed1997

Prevention of compartment syndrome associated with dorsal lithotomy position.

There is a clear association between the dorsal lithotomy position and the development of a postoperative compartment syndrome. Compartment syndrome occurs when elevated pressure in an osteofascial compartment compromises local perfusion and often results in neurovascular damage and permanent disability. Surgeons must recognize this association and provide appropriate preventative measures, have a high index of suspicion in all patients, and be prepared to make an early diagnosis when it is encountered. We will report four cases we encountered, discuss the etiology, analyze the literature, and propose a modification on patient positioning that has minimized the incidence of compartment syndrome at our institution. A variety of intraoperative events, including hypotension, hypoxemia, leg elevation, hip and knee flexion, direct pressure, and compressive bandages may all contribute to compartmental ischemia. Ischemia is followed by reperfusion, capillary leakage from the ischemic tissue, and a further increase in tissue edema. Increased edema causes further embarrassment of perfusion and perpetuation of the cycle, ultimately resulting in neuromuscular compromise secondary to ischemia. To prevent this destructive cycle, emphasis must be placed on maintaining a high index of suspicion in all patients, minimizing leg elevation, and on the importance of early diagnosis and intervention.

Adult↗
PubMed1990

Treatment of compartment syndrome in children.

A compartment syndrome is a symptom complex caused by elevated tissue pressure in a closed osseofascial compartment of a limb. Left unrecognized, it results in permanent damage to muscle and nerve in that compartment. The diagnosis of a compartment syndrome is contingent on the recognition of pain out of proportion with the injury as the most important early symptom. The pain is increased with passive stretching of the muscles in the involved compartment or on palpation of the involved muscles. Once the diagnosis is suspected, prompt treatment by appropriate fasciotomy should result in maintenance of normal limb function.

Adolescent↗
PubMed1990

Compartment syndromes in athletes.

Compartment syndromes occur frequently in the leg in association with athletics, but may occur in the forearm and many other muscular compartments as well. Similar inciting events may result in either acute or chronic forms with vastly different clinical presentations. With an understanding of the anatomy and pathophysiology, and the ability to directly measure compartment pressures, an accurate diagnosis can be readily made. Acute forms require immediate fascial release to minimize muscle and nerve injury. Surgical treatment of the chronic form is highly successful and usually allows an early return to athletics.

Athletic Injuries↗
PubMed2003

The abdominal compartment syndrome.

The abdominal compartment syndrome has received considerable attention only recently. It may be defined as adverse physiologic consequences that occur as a result of an acute increase in the intraabdominal pressure. The most common causes of ACS are haemorrhage, visceral oedema, pancreatitis, bowel distension, venous mesenterial obstruction, abdominal packs, tense ascites, peritonitis, tumor. The mostly affected organ systems include cardiovascular, pulmonary, renal, central nervous and splanchnic. The diagnosis depends on the recognition of the clinical syndrome followed by an objective measurement of intraabdominal pressure, preferably that of the urinary bladder. The treatment consists of adequate fluid resuscitation and surgical decompression when necessary. (Tab. 1, Ref. 29.).

Abdomen↗
PubMed1990

[Gluteal compartment syndrome].

The gluteal compartment syndrome is a condition which has rarely been described. Most frequently, it is caused by violent injury. A case which was precipitated by intramuscular injection in connection with anticoagulation treatment and which involved the sciatic nerve is described.

Buttocks↗
PubMed2003

Diagnosis, treatment options, and rehabilitation of chronic lower leg exertional compartment syndrome.

Chronic exertional compartment syndrome of the lower leg is a well-described and documented cause of exercise-related pain in recreational, elite, and military athletes. Although this condition is common, the exact underlying mechanisms, those most at risk, long-term effects on muscular strength if unrecognized, and prevention strategies are relatively uncertain. Runners are most commonly affected and can be markedly impaired by the recurrent, often predictable pain that develops with exercise. An accurate history, high index of suspicion, and compartment pressure testing before and after symptomatic exercise confirms the diagnosis. Conservative therapy is minimally effective. Fasciotomy is the treatment of choice for athletes who are unwilling to modify their exercise or sport.

Chronic Disease↗
PubMed1994

Compartment syndrome of the lower extremity.

Compartment syndrome is a devastating consequence of extremity trauma that is preventable with early recognition and treatment. A high index of suspicion and careful clinical evaluation will detect most impending or established compartment syndromes. Compartmental pressure measurements can be a useful adjunctive evaluation. Once the diagnosis of compartment syndrome is confirmed, or highly suspect, fasciotomy should be performed without delay. The functional and cosmetic results of fasciotomy are always acceptable if done early. The results of inadequate treatment of compartment syndrome are never satisfactory.

Compartment Syndromes↗
PubMedDate not supplied

Abdominal compartment syndrome.

TOPIC: Abdominal compartment syndrome (ACS) in blunt and penetrating abdominal trauma. PURPOSE: To review the clinical manifestations, pathophysiology, and nursing management of patients with ACS. SOURCES: Published literature, case study. CONCLUSIONS: Trauma nurses play a key role in early identification and management of ACS. Priorities include knowledge of signs and symptoms, methods of measurement of ACS; specifics of wound care, psychosocial interventions, and key factors in discharge planning.

Abdominal Injuries↗
PubMed1997

The abdominal compartment syndrome.

The abdominal compartment syndrome refers to the alterations in respiratory mechanics, hemodynamic parameters and renal function that occur as a result of a sustained increase in intra-abdominal pressure. The syndrome may follow a diverse series of insults, including laparotomy for severe abdominal trauma, ruptured abdominal aortic aneurysm and intra-abdominal infection. Diagnosis depends on recognizing the clinical picture in patients at risk, followed by an objective measurement of intra-abdominal pressure. Successful management may require abdominal decompression with temporary abdominal closure. Despite urgent decompression, the death rate is high because of the severity of the patients' underlying illness.

Abdomen↗
PubMed2001

[The abdominal compartment syndrome].

The abdominal compartment syndrome (ACS) causes dysfunctions of various organs through a progressive unphysiologic increase of the intraabdominal pressure. While the primary ACS is a result of the underlying disease/injury, secondary ACS is caused by surgical interventions. In the severely injured patient intra- and/or retroperitoneal bleeding, edema of viscera due to systemic ischemia reperfusion injury following hemorrhagic shock, abdominal/pelvic packing, and laparotomy closure under tension lead to ACS. The clinical signs of ACS are a tense abdomen with a decreased abdominal wall compliance. Early signs of ACS are a rise in inspiratory pressure and oliguria. Manifest ACS results in anuria, respiratory failure, reduced intestinal perfusion, and low cardiac output syndrome. If untreated, patients die due to left ventricular failure. Diagnosis of ACS is made using the patient's history including the injury pattern, the symptoms, the time period between injury and the occurrence of organ dysfunctions, and the physiologic response to decompression. Frequent determinations of the bladder pressure represent the "golden standard" for early recognition of ACS. Decompressive laparotomy should be performed with a bladder pressure > or = 20 mmHg and rapidly restores impaired organ functions. In the case of a multiple injured patients in shock or with associated severe head injury decompressive laparotomy may even be carried out at a lower bladder pressure. The abdomen is left open. In most patients staged laparotomy is necessary. The final closure of the abdominal wall is carried out after the edema have resolved between day 6 and 8 after primary laparotomy.

Abdomen↗
PubMed2003

Mesh hood fascial closure in renal allograft compartment syndrome.

Renal allograft compartment syndrome (RACS) is an underreported and poorly described surgical complication of renal transplantation. It occurs when a tight fascial closure compresses the graft in its limited retroperitoneal space. Without early recognition and reexploration, graft loss is inevitable. We describe a technique using a polypropylene mesh fascial closure (MHFC) to prevent and treat RACS. MHFC was performed primarily to prevent RACS and secondarily to treat this complication. Between April 2001 and October 2002, 16 patients undergoing 17 renal transplants underwent MHFC. Mean recipient body weight was 17% less than the mean donor weight. Mean follow-up was 9 months. Mean serum creatinine after primary MHFC was 148.4 micromol/L. Three of four patients with RACS regained function following secondary MHFC and had a mean serum creatinine of 155.3 micromol/L. Wound complications were seen in 5 (31%) with no wound or mesh infections and one patient was diagnosed with a lymphocele. We conclude that MHFC can be safely performed after kidney transplantation to prevent or treat RACS.

Compartment Syndromes↗
PubMedDate not supplied

[Efficacy of decompression treatment of abdominal compartment syndrome].

INTRODUCTION: Abdominal compartment syndrome (ACS) is an entity that represents a latent problem in the patient subjected to laparotomy. OBJECTIVE: To evaluate the effectiveness of decompressive treatment of ACS. MATERIAL AND METHODS: We studied patients subjected to decompressive treatment for diagnosis of SCA from May 1 to November 30, 2001 prospectively. We evaluated intraabdominal pressure (IAP), peak pressure of air way (J)PVA), oxygen available index (OAi), ventilation-perfussion index and uresis, before, after, and at 48 h of decompressive surgery. The data were treated statistically with paired student t test taking as significant p < 0.05 using percentages for qualitative variables and average with standard deviation for quantitative variables. RESULTS: We included 10 patients; three died (30%). Alone it VP & it descended significantly after compression (1 > < 0.05). Uresis, PPVA, OlA and VPI were carried out 48 h of decompressive surgery. CONCLUSIONS: Decompressive treatment is effective in ACS, showing immediate decreased of IAP and improvement of the hemodynamic variables after 48 h post-surgery.

Abdomen↗
PubMedDate not supplied

Abdominal compartment syndrome.

BACKGROUND: Abdominal compartment syndrome (ACS) is a systemic syndrome involving derangement in cardiovascular haemodynamics, respiratory and renal functions as a result of sustained increase in intra-abdominal pressure (IAP) ending in multi-organ failure. It is a life threatening emergency and requires prompt action and treatment. For the last 20 years, there has been more awareness among surgeons and intensivists of ACS being a distinct disease entity but still widespread ignorance prevails. Presentation can be acute, chronic and acute on chronic. Initial diagnosis is clinical, confirmed by measurement of IAP. Treatment is abdominal decompression by laparostomy and delayed abdominal closure. Despite prompt treatment mortality remains high. Awareness among surgeons has increased because laparoscopy has resulted in determination of IAP as a readily measurable quantity and also they have been able to appreciate the benefit of abdominal decompression by performing repeated planned laparotomies for trauma. METHODS: A medline, pubmed and Cochrane database search was performed and the articles found were cross referenced. RESULTS AND CONCLUSION: Clinical diagnosis is not easy and serial urinary bladder pressure (UBP) monitoring leads to early diagnosis. Treatment is by laprostomy to decompress the abdomen followed by delayed abdominal closure.

Abdomen↗
PubMedDate not supplied

[Early diagnosis and risk factors associated with abdominal compartment syndrome].

INTRODUCTION: Abdominal compartment syndrome (ACS) is a clinical entity that develops after sustained and uncontrolled intraabdominal hypertension (IAHT). The ACS is clinically characterized by a massively distended abdomen and respiratory, cardiovascular, neurologic, and renal dysfunction. OBJECTIVE: The goal of this study was to demonstrate the benefit of early diagnosis of intra-abdominal hypertension and ACS and to identify risk factors associated with mortality. MATERIAL AND METHODS: We used a prospective study that included all patients admitted to Hospital de Especialidades Miguel Hidalgo with known ACS risk factors between January 2002 and December 2003. All patients were submitted to systematic measurements of intra-abdominal pressure (IAP). Those patients with grade III-IV IAHT were treated with decompressive laparotomy. RESULTS: Included in the study were 32 patients (23 males and 9 females). Mean age was 45.0 +/- 18.34 years. Twenty three patients developed IAHT grade I-II (group I) and nine developed grade IIIIV (group II). All group II patients were treated with abdominal decompression. The most common clinical entities associated were closed abdominal trauma (28%), hernias (15%), intestinal occlusions: (12.5%), acute pancreatitis (9.4%) and mesenteric ischemia (6.3%). Grade III-IV IAHT was statistically associated with reoperation (p = 0.038), acidosis (p = 0.003), anuria (p < 0.001) and sustained arterial hypotension (p = 0.004). The significant variables associated to mortality were anuria (p = 0.024) and grade III-IV IAHTA (0.017). CONCLUSIONS: It is possible to make an early diagnosis of IAHT and ACS with an indirect measurement of IAP. The most important factors related to mortality are anuria and IAHT.

Abdomen↗
PubMed2000

[Abdominal compartment syndrome: prevention and treatment].

UNLABELLED: Abdominal compartment syndrome is defined by increased intraabdominal pressure above 20 mmHg with increased pulmonary peak pressure and oliguria. In primary abdominal compartment syndrome the increased intraabdominal pressure is caused directly by peritonitis, ileus or abdominal and pelvic trauma. Secondary compartment syndrome is a result of forced closure of the abdominal wall after abdominal surgery. The effects are decreased cardiac output, pulmonary atelectasis, oliguria to anuria and hepatic as well as intestinal reduction of perfusion. Effective monitoring is done by standardised measuring of urinary bladder pressure. Normal values are between 0 and 7 cm H2O, after elective laparotomies 5-12 cm H(2)0. Above 25 cm H(2)0 they are definitely pathological. For the prevention and therapy of manifested abdominal compartment syndrome the application of a laparostomy using a resorbable mesh is recommended. Between 1988 and 1999 we applied a laparostomy to lower the intraabdominal pressure in 377 patients. In 16% of the cases it was indicated by primary abdominal compartment syndrome with a bladder pressure of 31 +/- 4 cm H(2)0 preoperatively, which could be lowered to 17 +/- 4 cm H(2)0 by laparostomy. An early reconstruction of the abdominal wall could be performed in 18% of the cases. CONCLUSIONS: The abdominal compartment syndrome is an often underestimated problem in abdominal surgery involving multiple organ systems. The temporary laparostomy lowering intraabdominal pressure rather than a forced closure of the abdominal wall should be used in all circumstances.

Abdomen↗
PubMed2000

Chronic anconeus compartment syndrome: A case report.

Compartment syndrome of the forearm is commonly associated with the volar compartment. We present a case of compartment syndrome of the anconeus muscle. Release of the anconeus muscle fascia provided relief of symptoms.

Adult↗