[Neuropathy of common sciatic nerve secondary to compartment syndrome as a complication after bariatric surgery]

With regards to the use of bariatric surgery on very obese patients and prolonged interventions, isolated cases of a compartment syndrome by compression and secondary rhabdomyolysis have been described. We describe a case which presented with a compartment syndrome, rhabdomyolysis and neuropathy of the common sciatic nerve.

A 39 year old male with morbid obesity and high blood pressure, who after being subjected to 5 hours long bariatric surgical intervention, presented with intense pain, muscle binding and paresis in the musculature dependent on left common sciatic nerve. A creatinkinase (CK) level of 78,000 IU and volume increase of the left gluteal compartment were noted. On serial computarized tomography scans this increased leading to gluteal atrophy and ischiotibials. Evolution was negative without functional recovery and poor pain control. The patient presented with a compartment syndrome and secondary rhabdomyolysis triggered by the pressure on the gluteal zone on the operating table. The prolonged duration of the surgery, obesity and microvascular affectation due to hypertension, could be factors implicated in the development of the syndrome. The affectation of the sciatic nerve, not described as a complication of this type of surgery, is explained by pressure exercised on the compartment block on the sciatic nerve, with secondary ischaemia.

Early determination of CK, carrying out postural changes during surgery and early post-operative neuromuscular examination, looking for signs of compartment syndrome, should be systematically carried out after bariatric surgery. The early carrying out of a decompressive fasciotomy considering a compartment syndrome could reduce or avoid the neurological complications.