Paediatric Hand Compartment Syndrome Secondary to Intravenous Contrast Extravasation: A Case Report

Iodinated contrast extravasation is usually self-limited; however, in confined regions such as the dorsum of the hand - especially in paediatric patients - it can progress to acute compartment syndrome. We report a 9-year-old girl who developed hand compartment syndrome following extravasation of 50 mL iohexol (350 mgI/mL) via a 22G catheter during contrast-enhanced abdominal computed tomography. Despite standard extravasation management, symptoms progressed rapidly. Compartment syndrome was diagnosed clinically based on pain disproportionate to injury, refractory to analgesics, exacerbated by passive stretch, with paraesthesia and prolonged capillary refill. Emergency decompression was performed through five incisions. Delayed primary closure was achieved on postoperative day 5 without vacuum-assisted closure or skin grafting. At 6-month follow-up, grip strength equalled the contralateral side and QuickDASH score was 0. This case emphasises that moderate-volume contrast extravasation can rapidly cause compartment syndrome in the paediatric hand, and that standard extravasation protocols become contraindicated once compartment syndrome is suspected. Level of Evidence: V (Therapeutic).