Bilateral atraumatic acute anterior compartment syndrome of the legs with rhabdomyolysis and acute kidney injury

Acute Compartment Syndrome (ACS) occurs within closed fascial compartments where the intra-compartmental pressure increases progressively, resulting in reduced tissue perfusion within the compartment [1]. The increase in interstitial pressure eventually overcomes the capillary perfusion pressure, resulting in a state of tissue hypoxia. Once the interstitial pressure rises >30 mmHg or within 25 mmHg of the diastolic pressure, muscle ischemia begins [2]. Hypoxic injury releases metabolites that trigger further inflammation and further increase in compartmental pressure with progressive tissue injury. While ACS can occur in numerous locations including abdomen, thoracic cavity and brain, the commonest form is seen in the muscular compartments of the limbs, primarily the lower limbs.