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Compartment syndrome is defined as a symptom complex caused by increased pressure of tissue fluid in a closed osseofascial compartment which interferes with circulation to the myoneural components of the compartment. Bilateral compartment syndrome of the legs is a rare presentation requiring emergent surgical intervention. In a recent case report (Khan et al 2012) there have been only eight reported cases cited with bilateral compartment syndrome. Heroin abuse is known to cause compartment syndrome, traumatic and atraumatic rhabdomyolysis. Hypothyroidism can also independently present with rhabdomyolysis. Case presentation: We present a case of a 22 years old female who presented with bilateral swelling of the legs with associated loss of sensation having spent two days kneeling against the wall following IV heroin abuse. She presented to the emergency department with bilateral swelling of the legs with loss of sensation. She was diagnosed with compartment syndrome requiring emergent bilateral 4 compartment fasciotomy of the lower extremities. Inspite of aggressive fluid resuscitation she developed rhabdomyolysis complicated by acute renal failure requiring dialysis. She made a full recovery with full return of her renal as well as motor and sensory function. Conclusion: We discuss this interesting case of bilateral compartment syndrome in a heroin abusive patient with history of hypothyroidism complicated by rhabdomyolysis and acute renal failure. There have been isolated case reports of bilateral compartment syndrome following prolonged surgery. High index of suspicion, early recognition and therapeutic intervention is the key to good outcome.We discuss the etiopathology and management options of rhabdomyolysis. Treating the comorbities like hypothyroidism is also important for the recovery.

panamerican journal of trauma, critical care and emergency surgery

Bilateral Atraumatic Compartment Syndrome of the Legs Leading to Rhabdomyolysis and Acute Renal Failure Following Prolonged Kneeling in a Heroin Addict. A Case Report and Review of Relevant Literature