Acute Compartment Syndrome Which Causes Rhabdomyolysis by Carbon Monoxide Poisoning and Sciatic Nerve Injury Associated with It: A Case Report

Abstract

Rhabdomyolysis is most frequently caused by soft tissue injury with trauma to the extremities. Non-traumatic rhabdomyolysis may be caused by alcohol or drug abuse, infection, collagen disease, or intensive exercise, but incidence is low. In particular, rhabdomyolysis resulting from carbon monoxide poisoning is especially rare. If caught before death, carbon monoxide poisoning has been shown to cause severe muscle necrosis and severe muscle damage leading to acute renal failure. In cases of carbon-monoxide-induced rhabdomyolsis leading to acute compartment syndrome in the buttocks and sciatic nerve injury are rare. We have experience treating patients with acute compartment syndrome due to rhabdomyolysis following carbon monoxide poisoning. We report the characteristic features of muscle necrosis observed during a decompression operation and magnetic resonance imaging findings with a one-year follow-up in addition to a review of the literature.

Keywords: Carbon monoxide poisoning; Gluteal compartment syndrome; Magnetic resonance imaging; Rhabdomyolysis; Sciatic neuropathy.

Fig. 1. (A) Axial T1-weighted image shows no enhancement. (B) Coronal T2 weighted image shows heterogenous high signal intensity in the right gluteus maximus, medius, minimus.

Fig. 2. Axial T2-weighted images show heterogenous high signal intensity in the right gluteus maximus, medius, and minimus. Swelling is especially apparent in the right gluteus medius, and minimus muscles.

Fig. 3. Axial (A) and coronal (B) gadolinium-enhanced T1-weighted images show faint intramuscular and peripheral enhancement of muscle and subcutaneous fat.

Fig. 4. The results of surgery confirmed the presence of necrotic muscle. Muscle is pale, there was no bleeding, there is no contractility even following electrical stimulation, and there is no elasticity making it easily peeled off with curette.