[Well leg compartment syndrome during prolonged surgery in the lithotomy position]

We experienced a case of the well leg compartment syndrome (WLCS) during total pelvic exenteration in a 54-year-old woman. She was placed in the head down-lithotomy position and her both lower legs were attached with elastic stocking and intermittent pneumatic compression for prevention of deep vein thrombosis. The surgery lasted for 13 hr and 15 min. Her vital signs stayed stable during the procedure. After emergence from anesthesia, she complained of severe bilateral crural pain. We found that her calves were swollen and rigid. Creatinin kinase increased to 40120 U x l(-1) the following morning. She was diagnosed as WLCS, and the left fibula paralysis remained as legacy of WLCS. WLCS during surgery is caused by inappropriate positioning of the lower limbs, in contrast to a compartment syndrome caused by trauma or injury. Its etiology consists of multi-factors e.g., prolonged surgery in the lithotomy position and hypo-perfusion. We emphasize the importance of both prevention and early treatment of WLCS. All anesthesiologists should pay attention to WLCS.