Gluteal compartment syndrome: a case report

Abstract

Introduction: Gluteal compartment syndrome is a rare, often unrecognized syndrome that may manifest as renal failure, sepsis, and death. Delay in diagnosis can result in significant morbidity and possible mortality. We report a case of occult gluteal compartment syndrome causing unresolving rhabdomyolysis.

Case presentation: A 50-year-old Caucasian American man with history of chronic obstructive pulmonary disease was admitted status post fall and loss of consciousness for an unknown duration. Initial work-up revealed severe rhabdomyolysis, opioid abuse and acute renal failure. Inspite of three days of intensive therapy his condition did not improve and his renal failure worsened. On improvement of his condition three days later, he indicated some discomfort in his right hip. Physical examination was significant for swelling of the right gluteal region, which was tender and firm on palpation. A non-contrast CT scan showed evidence of gluteal compartment syndrome and emergent surgery resulted in significant improvement of his condition.

Conclusion: Gluteal compartment syndrome most commonly occurs in individuals with altered mental status due to drugs or alcohol, who remain in one position for an extended period of time. This prolonged compression leads to muscle damage, edema, and a full-blown compartment syndrome. Due to its anatomic location and rarity, diagnosis is often missed or delayed, resulting in significant morbidity and possible mortality. The mainstay of treatment is fasciotomy.

Figure 1

Right hip of the patient showing increased swelling, tenderness and firmness on palpation.

Figure 2

CT scan of the pelvis - Fullness of the right gluteal maximus and medius muscles, possibly secondary to edema or inflammation or compartment syndrome.

Figure 3

MRI pelvis. Enlargement of right gluteus minimus and medius muscles secondary to edema or hemorrhage with compartment syndrome.