Gentry Richard, Anand Prince Mohan, Kamal Ahmed I, Alqassieh Ahmad Saleh, Mahmood Ammar Obaid, Ayrapetyan Mesrop, Saud Amer Altiti Monther
Edward Via College of Osteopathic Medicine (VCOM), 2265 Kraft Drive SW, Blacksburg, VA, USA.
Mid-Carolinas Kidney Transplant Program, Medical University of South Carolina, 820 West Meeting St, Lancaster, SC, USA.
World J Surg Oncol. 2025 Feb 14;23(1):50. doi: 10.1186/s12957-025-03696-3.
Acute compartment syndrome (ACS) is characterized by increased pressure within the fascial network of any muscle, leading to impaired circulation and potential myonecrosis. Very rarely, soft tissue infiltration by metastatic disease can cause localized swelling that increases intercompartmental pressures. We report an unusual case of invasive, poorly differentiated upper gastrointestinal adenocarcinoma presented by acute compartment syndrome of the lower extremity and subsequent acute kidney injury (AKI) caused by myonecrosis-induced cast nephropathy.
A 52-year-old male presented to the hospital with rapid onset unilateral right leg pain and tense edema accompanied by myonecrosis with no explicable etiology complicated by AKI. Surgical fasciotomy and subsequent muscle biopsy yielded poorly differentiated non-small cell adenocarcinoma. CT imaging identified diffuse adenopathy along with abnormal thickening of the distal esophagus, gastroesophageal (GE) junction, and gastric cardia. Further investigation via upper esophagogastroduodenoscopy (EGD) revealed an exophytic mass in the distal esophagus extending into the stomach. This lesion was confirmed via biopsy as primary invasive poorly differentiated upper gastrointestinal (UGI) adenocarcinoma.
This case highlights the need for clinicians to implement high-risk screening for UGI cancers and consider skeletal muscle metastasis as a cause of nontraumatic ACS. It emphasizes the importance of interdisciplinary collaboration in managing such complex cases and the role of timely surgical and oncological intervention in preventing long-term complications of ACS. Furthermore, it highlights the potential use of more efficient and specific MR imaging techniques to diagnose ambiguous cases of ACS.
急性筋膜室综合征（ACS）的特征是任何肌肉的筋膜网络内压力升高，导致循环受损和潜在的肌肉坏死。非常罕见的是，转移性疾病引起的软组织浸润可导致局部肿胀，从而增加筋膜室内压力。我们报告了一例不寻常的侵袭性、低分化上消化道腺癌病例，该病例表现为下肢急性筋膜室综合征，随后因肌肉坏死性管型肾病导致急性肾损伤（AKI）。
一名52岁男性因突发右下肢单侧疼痛、紧张性水肿伴肌肉坏死入院，病因不明，并伴有AKI。手术切开筋膜减压及随后的肌肉活检显示为低分化非小细胞腺癌。CT成像显示弥漫性淋巴结肿大，同时远端食管、胃食管（GE）交界处和胃贲门异常增厚。通过上消化道内镜检查（EGD）进一步检查发现远端食管有一个外生性肿块延伸至胃内。经活检证实该病变为原发性侵袭性低分化上消化道（UGI）腺癌。
本病例强调临床医生需要对上消化道癌症进行高危筛查，并考虑骨骼肌转移作为非创伤性急性筋膜室综合征的病因。它强调了跨学科合作在处理此类复杂病例中的重要性，以及及时的手术和肿瘤学干预在预防急性筋膜室综合征长期并发症方面的作用。此外，它还强调了使用更高效、更特异的磁共振成像技术诊断急性筋膜室综合征疑难病例的潜在用途。
