A rare case of thigh compartment syndrome

Abstract text (incl. references and figure legends)

Forty two-year-old man, who during a game of soccer suffered a left thigh trauma, due to a hip hyperabduction mechanism. He presented medial side swelling, with a adductors hematoma diagnosed, instituting conservative treatment. Due to clinical worsening, he returned to the urgency 2 days later, with a hematoma under tension and intense pain with passive hip abduction. He had present distal pulses. CT angiography revealed extensive hematoma on the anterior and medial thigh face, measuring 11x7x13cm, originating from a posterior branch of the left internal iliac artery. Due to considerable worsening of the pain, compartment syndrome of the left thigh was diagnosed, having been submitted to fasciotomies and decompression of the anterior and posterior compartments via lateral and medial approach. During the postoperative period, there was a drainage of 1200cc of blood, although the patient remained hemodynamically stable. He underwent angioembolization of the posterior branch of internal iliac artery. One day after the angioembolization he had a recurrence of hemorrhage. A new CT angiography revealed a hematoma in the obturator region measuring 13x12x6.5cm, new extravasation was observed at the level of the obturator branch of the internal iliac artery. It was made new angioembolization with resolution of the hemorrhage. Two weeks after the last procedure the fasciotomies were closed. At the moment the patient is stable, with clinical resolution of the hematoma, without further complications. The association of the syndrome compartment with obturator artery injury is a situation rarely described in the literature. A high clinical suspicion is necessary in the diagnosis of compartment syndrome of the thigh with arterial origin. This entity should not be neglected given its serious consequences.doi:10.1016/j.injury.2009.03.016.doi.org/10.1016/j.avsg.2012.06.026.doi: 10.1093/jscr/rjaa546.doi.org/10.2106/JBJS.CC.18.00506.

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