Compartment Syndrome of the Gluteal Region: A Rare Condition Requiring a High Index of Suspicion

Compartment syndrome, an exceptionally rare condition, is a surgical emergency that can quickly escalate to limb ischemia and necrosis without treatment. Most cases occur post-trauma, typically affecting the anterior compartment of the leg. Patients present with pain out of proportion to their physical examination findings and often have an early hallmark discovery of pain with passive extension. Compartment syndrome of the buttock requires an even higher index of suspicion, as the condition is even more uncommon, and the diagnosis is complicated by it being difficult to palpate the affected area and passively extend the leg when the patient is supine.

This case report presents an 83-year-old female with compartment syndrome of the left gluteal region, status post-fall 1 day earlier. She was admitted to the medical team for observation and failed to respond to narcotic pain medication. The physical examination revealed firm, tense, left gluteal compartments with buttock hematoma and surrounding muscle induration, significant pain, and extremity weakness in the sciatic nerve distribution. An emergent fasciotomy was performed to decompress the affected compartments.

All physicians must be mindful of gluteal compartment syndrome in patients complaining of buttock pain, especially after pelvic trauma, who present with buttock swelling, tense gluteal compartments, and severe gluteal pain. A delay in diagnosis or treatment can lead to severe consequences, including disability, irreversible gluteal muscle damage, sciatic nerve dysfunction, kidney failure, or death.