Djelti Abdellatif, Loukriz Amira, Demdoum Youcef, Bouras Amine Mohamed, Debbache Youcef Seddik, Bouhraoua Mahfoud Nabil
University of Algiers, Department of orthopedic and trauma surgery, University Hospital Center Lamine DEBAGHINE, Bab El Oued, Algiers, Algeria.
Orthopedic and trauma surgery, Public Hospital Establishment of EFRI, Djanet, Algeria.
Int J Surg Case Rep. 2024 Dec;125:110557. doi: 10.1016/j.ijscr.2024.110557. Epub 2024 Nov 6.
Compartment syndrome is a surgical emergency caused by elevated pressure within a closed fascial compartment, leading to compromised tissue perfusion and the potential for irreversible damage if not treated promptly. This report presents a rare case of upper limb compartment syndrome in a COVID-19 patient on anticoagulation therapy following multiple failed venipuncture attempts. This work has been reported in line with the SCARE criteria.
A 67-year-old man with hypertension, diabetes, and congenital hydrocephalus was admitted for COVID-19 pneumonia. He required anticoagulation therapy with Enoxaparin due to his high risk for thromboembolic events. Following multiple failed attempts to secure venous access in the right upper limb, the patient developed severe pain, swelling, and numbness in the limb. Clinical examination revealed pallor, paresthesia, and pulselessness, raising suspicion of compartment syndrome. Ultrasonography confirmed the absence of radial and ulnar arterial flow, with evidence of significant muscular edema and hematoma formation in the anterior compartment of the arm. Due to the patient's pulmonary compromise and elevated risk for general anesthesia, the decision was made to perform a fasciotomy under the WALANT (Wide Awake Local Anesthesia No Tourniquet) technique. Following the procedure, pulses were restored after evacuation of a deep hematoma compressing the humeral artery, with immediate improvement in hand perfusion. The patient was transferred back to the infectious diseases department for continued COVID-19 management, and the postoperative course was uneventful. At 6-month follow-up, the patient had fully recovered mobility of the shoulder, elbow, wrist, and fingers.
This case underscores the rare development of upper limb compartment syndrome in a patient on anticoagulation therapy for COVID-19, likely due to venipuncture-related trauma. It highlights the challenges of diagnosing and managing compartment syndrome in critically ill patients, and demonstrates the utility of the WALANT technique in performing fasciotomy in high-risk patients. Early recognition and timely intervention were crucial in ensuring the patient's full functional recovery.
Compartment syndrome should be considered in patients on anticoagulation therapy, particularly those with multiple venipuncture attempts. The WALANT technique provides a viable surgical option for fasciotomy in critically ill patients.
骨筋膜室综合征是一种外科急症，由封闭的筋膜室内压力升高引起，若不及时治疗，会导致组织灌注受损并有可能造成不可逆的损伤。本报告介绍了一例罕见的新型冠状病毒肺炎（COVID-19）患者在多次静脉穿刺失败后接受抗凝治疗时发生上肢骨筋膜室综合征的病例。本研究已按照SCARE标准进行报告。
一名67岁男性，患有高血压、糖尿病和先天性脑积水，因COVID-19肺炎入院。由于他发生血栓栓塞事件的风险较高，需要使用依诺肝素进行抗凝治疗。在右上肢多次静脉穿刺失败后，患者出现上肢严重疼痛、肿胀和麻木。临床检查发现皮肤苍白、感觉异常和无脉，怀疑为骨筋膜室综合征。超声检查证实桡动脉和尺动脉无血流，且有证据表明手臂前侧肌间隔有明显的肌肉水肿和血肿形成。由于患者存在肺部功能不全以及全身麻醉风险升高，决定在清醒局部麻醉无止血带（WALANT）技术下进行筋膜切开术。术后，在清除压迫肱动脉的深部血肿后恢复了脉搏，手部灌注立即得到改善。患者被转回传染病科继续进行COVID-19治疗，术后过程顺利。在6个月的随访中，患者肩部、肘部、腕部和手指的活动能力已完全恢复。
本病例强调了COVID-19患者在接受抗凝治疗时罕见地发生上肢骨筋膜室综合征，可能与静脉穿刺相关创伤有关。它突出了在危重症患者中诊断和管理骨筋膜室综合征的挑战，并证明了WALANT技术在高危患者中进行筋膜切开术的实用性。早期识别和及时干预对于确保患者的完全功能恢复至关重要。
接受抗凝治疗的患者，尤其是那些多次进行静脉穿刺的患者，应考虑发生骨筋膜室综合征的可能性。WALANT技术为危重症患者进行筋膜切开术提供了一种可行的手术选择。
