Fatal acute compartment syndrome in patients after surgical treatment: 2 case reports

This report describes 2 cases died from acute compartment syndrome after surgical treatment. Case 1 was a 30-year-old man suffered from upper arm fracture, who complicated with the acute compartment syndrome at the following day after surgical fixation, and died 6 days later. Case 2 was a 9-year-old woman sustained medial malleolus sprain, who experienced plaster cast immobilization and died 7 days after management. At autopsy, swollen and necrotized skeletal muscles with edema were detected in the involved region in both cases. Histopathologically, hemorrhage and infiltration of neutrophils were observed in the skeletal muscles. Intensive positive immunoreactivity of myoglobin was detected in granular casts in distal convoluted tubules by immunohistochemical staining. Marked elevation in serum urea nitrogen uric acid, creatinine and C-reactive protein levels was demonstrated by serological tests. The pathological findings and postmortem biochemical measurements indicated that both victims died due to myoglobinuric renal failure.