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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 2  |  Issue : 1  |  Page : 15-16

Compartment syndrome: A rare complication of varicose vein surgery


Department of Orthopaedics, IGIMS, Patna, Bihar, India

Date of Web Publication16-Aug-2019

Correspondence Address:
Dr. Ritesh Runu
Department of Orthopaedics, IGIMS, Patna - 800 014, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODP.JODP_5_19

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  Abstract 


Varicose vein is a common surgical problem. It is commonly reported in surgery OPD and being treated by stripping. We report a case of 25year male who presented with cold, pulseless, pale and senseless left lower limb following stripping 4 days back. He had stitched wound up to groin on the medial aspect of leg and groin, patchy skin necrosis and swelling of whole lower limb. His urine output was reduced. Immediate fasciotomy was done. Urgent colour Doppler showed deep venous thrombosis and multiple large hematomas in the thigh. Due to development of septicemia and renal failure above knee amputation was done. Postoperatively the patient required two debridements and then closure was done. The patient improved gradually. We conclude that before doing venous stripping thorough preoperative evaluation is needed and post operative care should be taken to avoid complications.

Keywords: Compartment syndrome, varicose vein, venous stripping


How to cite this article:
Runu R. Compartment syndrome: A rare complication of varicose vein surgery. J Orthop Dis Traumatol 2019;2:15-6

How to cite this URL:
Runu R. Compartment syndrome: A rare complication of varicose vein surgery. J Orthop Dis Traumatol [serial online] 2019 [cited 2019 Sep 21];2:15-6. Available from: http://www.jodt.org/text.asp?2019/2/1/15/264619




  Introduction Top


Varicose vein is a common surgical problem.[1] It is managed by bandaging, stocking, injection sclerotherapy, and venous stripping.[2],[3],[4] Usually, venous stripping carries minor complications. Here, we describe a case of irreversible compartment syndrome of the leg in a 25-year-old male following venous stripping who had to undergo above knee amputation as a life-saving procedure.


  Case Report Top


A 25-year-old male presented with cold, pulseless, pale, and senseless left lower limb with patchy skin necrosis over leg 4 days following venous stripping. His urine output was nil in the last 24 h. On local examination, there was a multiple-stitched wound over leg and groin along the saphenous vein. The left leg and thigh were swollen, tense with multiple blisters. The bladder was found to be empty.

In emergency, fasciotomy of the leg and thigh was done to decompress the compartment. There were big hematomas both in thigh and leg. The muscles were beefy red, noncontractile, and nonbleeding.

Laboratory investigations revealed hemoglobin 9.4 gm%, serum sodium 113.6 mmol/l, and serum creatinine 6.8 mg/dl. To rule out bleeding disorder, prothrombin time, partial thromboplastin time, and international normalized ratio were done. It was within normal limits. The patient was on intravenous saline and antibiotics. Urgent Doppler study of the lower limb showed deep venous thrombosis and massive multiple hematomas in the leg and thigh. The arterial tree was apparent up to distal femoral artery.

Next day, the patient became toxic having fever 104°F and went in septicemic shock. His total leukocyte count was 19,200/cumm and his neutrophils were 91%. On an emergency basis, he was operated. An above knee guillotine amputation was done as a life-saving procedure. Postoperatively, the general condition and hematological parameters improved. The patient required two follow-up debridements. The wound was closed later once the girth of thigh reduced to the size of opposite normal thigh. The wound healed satisfactorily. The patient was discharged in satisfactory condition.


  Discussion Top


Venous stripping was first introduced by Friedrich von Trendelenburg in 1860.[5] It is commonly performed daycare surgery for venous disorder today. Ecchymosis or bruising is the most common complication.[6] Saphenous and sural nerve injury is also common.[6] Groin hematoma complicates 0%-5% of cases.[6] They usually resolve without treatment. Thromboembolic problems are rare.[7] Postoperative deep venous thrombosis is reported in 0.6% of cases.[8] It is one of the contraindications for venous stripping. Compartment syndrome is a very rare complication. We have found only two case reports after searching on electronic media.[9],[10] Its pathophysiology is not clear. It usually resolves without any intervention. In our case, probably, hematoma along the course of varicose vein and postoperative deep venous thrombosis was the main reason for compartment syndrome, which progressed leading to amputation. Since venous stripping is done by general surgeons, the diagnosis of compartment syndrome may be delayed or missed in such a patient as it happened in the present case also. Timely intervention might have saved the limb.


  Conclusion Top


Before venous stripping, one should do proper and comprehensive preoperative examination of the lower limbs to rule out deep venous thrombosis. Postoperatively, the patients should be kept under close observation for developing compartment syndrome. Since it is a daycare surgery, the patient should be instructed about the signs and symptoms to avoid this dreaded complication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005;15:175-84.  Back to cited text no. 1
    
2.
Hirsch SA, Dillavou E. Options in the management of varicose veins, 2008. J Cardiovasc Surg (Torino) 2008;49:19-26.  Back to cited text no. 2
    
3.
London NJ, Nash R. Clinical review on varicose veins. Br Med J 2000;320:1391-4.  Back to cited text no. 3
    
4.
Naoum JJ, Hunter GC. Pathogenesis of varicose veins and implications for clinical management. Vascular 2007;15:242-9.  Back to cited text no. 4
    
5.
Whiddon LL. Advances in the treatment of superficial venous insufficiency of the lower extremities. Proc (Bayl Univ Med Cent) 2007;20:136-9.  Back to cited text no. 5
    
6.
Bergan J. Surgical management of primary and recurrent varicose veins. In: Gloviczki P, Yao JS, editors. Handbook of Venous Disorders Guidelines of American Venous Forum. 2nd edn. London: Arnold Press, 2001:287-302.  Back to cited text no. 6
    
7.
Nagasaki K, Matsumoto K, Kaneda M, Shintani T, Shibutani S, Murayama T, et al. Pulmonary embolism after stripping of varicose veins. Int J Angiol 2002;11:245-7.  Back to cited text no. 7
    
8.
May R. Varicose veins. In: Surgery of the Veins of the Leg and Pelvis. Stuttgart: Thieme; 1979.  Back to cited text no. 8
    
9.
Watanabe Y, Saiki N, Makimura S, Sasaki T, Obitsu Y, Ishimaru S. Compartment syndrome after varicose vein surgery for legs. Jpn J Phlebol 2004;15:403-7.  Back to cited text no. 9
    
10.
Widmer MK, Hakki H, Reber PU, Kniemeyer HW. Rare, but severe complication of varicose vein surgery. Compartment syndrome. Zentralbl Chir 2000;125:543-6.  Back to cited text no. 10
    




 

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Introduction
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Discussion
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