Author: Yanithra Perera / Editor: Nick Tilbury / Codes: MuP2, SLO4, TP7 / Published: 29/10/2021
A 40-year-old female with no past medical history is brought into hospital with bilateral loss of sensation to her lower limbs.
She works as a professional dancer and was at a party the previous night. She consumed a large amount of alcohol and fell asleep whilst seated on the toilet. She woke up in the middle of the night, still seated on the toilet and unable to stand up. A cleaner found her early the next morning and called an ambulance.
Clinical examination in hospital reveals swollen, tense calves bilaterally. She also has a loss of sensation in both lower legs, most notable in the distribution of the common and superficial peroneal nerves. There is minimal pain on passive stretch of the calf muscles. Her feet feel cold and capillary refill is roughly 8 seconds in both feet. Dorsalis paedis is difficult to palpate on the right foot. She is also noted to have dark urine.
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Question 1 of 3
1. Question
What is the most likely diagnosis?
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Question 2 of 3
2. Question
Her creatinine kinase comes back as 103,000U/L. A clinical diagnosis of bilateral compartment syndrome with rhabdomyolysis is made. Plastic Surgeons take her to theatre for bilateral fasciotomies. The capillary refill, peripheral pulses and sensation improve in both her lower limbs.
Which compartment of the leg is most commonly affected by compartment syndrome?
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Question 3 of 3
3. Question
What is the upper limit of normal pressure within the compartment?
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8 responses
Nice one 😉
good case
good review of compartment syndrome
Most unusual and rather tragic case!
Good
Nice one 😜
Very good case. Very unusual though! Absolutely telling patients not to sleep off on the toilet seat…
Great Revision