Hoshino Koji, Nakamura Toru, Hayakawa Mineji, Itosu Yusuke, Saito Hitoshi, Hirano Satoshi, Morimoto Yuji
Department of Anesthesiology, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 0608648, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, N15W7, Kita-ku, Sapporo, Hokkaido, 0608638, Japan.
JA Clin Rep. 2019 Oct 23;5(1):65. doi: 10.1186/s40981-019-0286-2.
The right external iliac vein (REIV) is often used for portal vein reconstruction in patients undergoing pancreatoduodenectomy with portal-superior mesenteric vein resection. We report a case of cardiac arrest caused by acute lower leg compartment syndrome as a result of REIV resection.
A 53-year-old man underwent pancreatoduodenectomy with portal vein resection. Hyperkalemia progressed during surgery due to intestinal reperfusion injury, which caused recurrent ventricular arrhythmia required for cardio-pulmonary resuscitation. The surgery was discontinued after resuscitation, and portal vein reconstruction using the REIV was performed 2 days post-operatively. Acute compartment syndrome was diagnosed immediately following the surgery. Hyperkalemia progressed, causing pulseless ventricular tachycardia. Emergent fasciotomy was performed, but right leg dysfunction persisted after discharge.
REIV resection can cause lower-extremity acute compartment syndrome. The status, including intracompartmental pressure, of the lower extremity should be carefully observed after REIV resection during and after surgery.
在接受门静脉-肠系膜上静脉切除的胰十二指肠切除术患者中，右髂外静脉（REIV）常被用于门静脉重建。我们报告一例因REIV切除导致急性小腿骨筋膜室综合征而引发心脏骤停的病例。
一名53岁男性接受了门静脉切除的胰十二指肠切除术。手术期间，由于肠道再灌注损伤，高钾血症进展，导致反复出现室性心律失常，需要进行心肺复苏。复苏后手术停止，术后2天使用REIV进行门静脉重建。手术后立即诊断为急性骨筋膜室综合征。高钾血症进展，导致无脉性室性心动过速。紧急进行了筋膜切开术，但出院后右腿功能障碍持续存在。
REIV切除可导致下肢急性骨筋膜室综合征。手术期间及术后REIV切除后，应仔细观察下肢的状况，包括骨筋膜室内压力。
