[Myoglobinemia in a patient due to positioning during nephrectomy]

We report a case of myoglobinemia observed in the postoperative period due to forced positioning during nephrectomy. A 32-year-old male, weighing 93 kg, underwent the left nephrectomy due to renal cell carcinoma under general anesthesia with epidural block. The operation was performed uneventfully but he complained of severe pain in his right hip immediately after the recovery from anesthesia. Neither skin flush nor edema was observed and the other superficial tissue injury was not detected. On the day following the operation, severe myoglobinemia was observed and the serum myoglobin level increased to over 20,000 ng.ml-1. CT findings showed topical edema or necrosis of his right minor and medial gluteus muscle. Myoglobinemia continued only for 3 days after the operation without renal dysfunction. We may conclude that muscle injury during an operation followed by forced positioning for nephrectomy is caused not only by direct compression of the muscle, but also by obstruction of the profound intramuscular artery.