A Case of Crush Syndrome Associated with Prolonged Surgery in Dorsal Lithotomy Position for Recurrent Rectal Cancer

Tomoaki Karube, Yasuhisa Abe, Kenichi Saigou, Hiromiti Aoyama, Hiroyuki Hirasawa*, Takenori Ochiai** and Kazuaki Okuyama

Department of Surgery, Kouritu Tyousei Hospital
*Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
**Second Department of Surgery, Chiba University School of Medicine

We report a case of Crush Syndrome associated with prolonged colorectal surgery in dorsal lithotomy position. A-66-year-old man, who underwent low anterior resection for rectal carcinoma in 1995, had a locally recurrence 3. 5 years after the first operation. The recurrent tumor was resected by Miles operation, which lasted 14 hours 33 minutes with 4,390 ml of blood loss. The patient was fixed on the operating table in lithotomy position from the start of operation, and 11 hours after, his hip and knee joints were repositioned and strongly flexed for the peritoneal approach. One hour after repositioning, he had a hypotension and tachycardia. On the 1^st postoperative day, his legs were found to look purple. Acute renal failure developed with the elevation of serum creatinine and hyperkalemia. Continuous hemodiafiltration (CHDF) was initiated for 22 days. His renal function recovered, however, his legs motor function remained impaired. This case suggested that the duration of lithotomy position should be minimized.

Key words
crush syndrome, compartment syndrome, lithotomy position

Reprint requests
Tomoaki Karube Department of Gastrointestinal Surgey, Chiba Cancer Center 666-2 Nitonamachi, Chuuou-ku, Chiba, 260-8717 JAPAN

Accepted
March 22, 2000

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