A pitfall of protracted surgery in the lithotomy Position: lower extremity compartment syndrome

Although the lithotomy position is frequently used in urologic, gynecologic, and colorectal surgery, the potentially devastating complication of lower extremity compartment syndrome is not widely recognized. The authors report a 50-year-old woman who underwent 8 hours of colorectal surgery in the lithotomy position. After surgery she complained of bilateral calf pain and was noted to have episodes of ventricular tachycardia. After emergency dialysis for hyperkalemia, she required bilateral four-compartment calf fasciotomy. Prevention of compartment syndrome and its sequelae, when using the lithotomy position, requires minimizing the duration of time in lithotomy. If protracted surgery in lithotomy is necessary, the patient should be carefully monitored for compartment syndrome postoperatively. Urgent four-compartment fasciotomy is the treatment of choice if a compartment syndrome is clinically suspected.