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Review
. 2021 Dec 8;13(12):e20256.
doi: 10.7759/cureus.20256. eCollection 2021 Dec.

Atraumatic Bilateral Acute Compartment Syndrome of the Lower Legs: A Review of the Literature

Madeline Warren  1 , Govind Dhillon  1 , Joseph Muscat  1 , Ali Abdulkarim  2
Affiliations
Review

Atraumatic Bilateral Acute Compartment Syndrome of the Lower Legs: A Review of the Literature

Madeline Warren et al. Cureus. .

Abstract

Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health. A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included. In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy. This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.

Keywords: acute; atraumatic; bilateral compartment syndrome; rhabdomyolysis; spontaneous.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA 2020 flow diagram for ABACS review.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ABACS: acute bilateral atraumatic compartment syndrome
Figure 2
Figure 2. Bar chart showing cases by age group and gender.
ABACS: acute bilateral atraumatic compartment syndrome
Figure 3
Figure 3. Pie chart showing the most likely cause of patients with ABACS.
ABACS: acute bilateral atraumatic compartment syndrome; N/a = not applicable
See this image and copyright information in PMC

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