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Case Reports
. 2021 Feb 10:32:100411.
doi: 10.1016/j.tcr.2021.100411. eCollection 2021 Apr.

Good recovery without decompression fasciotomy for crush syndrome caused by using a Japanese-style toilet

Akinori Osuka  1 , Daiki Miyao  1 , Yuji Kuge  1 , Shinji Nakajima  1 , Yuichi Kuroki  1 , Masashi Ueyama  1
Affiliations
Case Reports

Good recovery without decompression fasciotomy for crush syndrome caused by using a Japanese-style toilet

Akinori Osuka et al. Trauma Case Rep. .

Erratum in

Abstract

We report a case of crush syndrome that developed while the patient was squatting to use a Japanese-style toilet. The patient was a 61-year-old male with an obese body. He was sitting on the toilet and couldn't stand up, and after a few hours, the landlord found him and called the emergency services. On presentation, the patient was hyperkalemic and in shock, and his serum creatine kinase levels rose to a maximum of 287,600 U/L. He was diagnosed with postural crush syndrome in both lower extremities due to squatting position in a Japanese-style toilet. Subjective symptoms, physical examination, and blood tests were monitored and the patient was observed. As a result, the patient could be treated conservatively without fasciotomy. Dialysis was not necessary because the fluid infusion maintained adequate urine output and corrected the hyperkalemia. Magnetic resonance imaging of both lower extremities showed multiple high-signal areas in the muscles of the bilateral thighs and lower legs. This case suggested that if the wound is closed, the peripheral pulse is palpable, and the patient's symptoms have improved, a fasciotomy should not be performed. People who are too heavy to squat may need to be careful when using this kind of toilet.

Keywords: Crush syndrome; Fasciotomy; Japanese-style toilet; Squatting position.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
Japanese-style toilet. The left panel shows a Japanese style toilet, and the right panel is a pictogram showing how to use it. A Japanese toilet requires squatting down to defecate.
Fig. 2
Fig. 2
Magnetic resonance imaging of both lower extremities shows multiple high-signal areas in the muscles of the bilateral thighs and lower legs.
See this image and copyright information in PMC

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