Lower limb compartment syndrome associated with Lloyd-Davies/lithotomy position in colorectal surgery

Lower limb compartment syndrome is a rare complication of surgical patients submitted to operation in the lithotomy/Lloyd-Davies position. The diagnosis and treatment of this feared complication should be promptly instituted otherwise the patient may have serious neuromuscular impairment, limb loss or even fatal outcome. Furthermore, rabdomyolysis and myoglobinuria may lead to acute renal failure. Among the factors involved in the development of this syndrome are prolonged operation time, elevation of the lower limbs, Trendelenburg position, metabolic acidosis and perioperative hypotension. The authors illustrate this rare and deadly complication after an abdominal perineal resection for a low rectal cancer in an otherwise healthy patient. Early fasciotomies of all three compartments of both legs led to complete functional recovery of both limbs and avoided more serious complications. The authors emphasize the importance of early recognition of this syndrome as well as immediate or even prophylactic intervention to avoid most common sequelae. Moreover, they point out some preventive measures that can be observed to lower the incidence of this condition in patients exposed for a long period to this position during colorectal or urological operations.