![]() WLCS was first reported in 1979 as a severe complication after the surgery in lithotomy position. Shoe-race sutures were used to close the wound gradually. ![]() Based on these findings, WLCS localized in the anterior and lateral compartments was diagnosed. Contrasting computed tomography (CT) showed swelling of the bilateral muscles in the anterior and lateral compartments without contrasting effect compared to the posterior compartments (Figure 1). The anterior and lateral compartment pressures in both legs had increased to 200 mmHg despite normal posterior compartment pressure (35 mmHg) or thigh compartment pressure (35 mmHg). The measurement was performed at three places of each compartment, and the average value was recorded. The compartment pressure was measured by an arterial line set with simple 18-gauge needle under the diastolic blood pressure of 98 mmHg. Serum creatine kinase was elevated to at 28000 U/l. No remarkable finding was appreciated on the posterior aspects of his lower legs. Initial evaluation of lower extremities revealed foot drop, swelling and tightness of the anterolateral aspects, and stretch pain on passive ankle planter flexion. Sixteen hours after the surgery, he complained of severe bilateral lower leg pain and swelling. No bleeding-promoting drug was used before and after the surgery. Continuous compression devices on both calves were used for venous thrombosis prophylaxis throughout the procedure. The operative position was lithotomy position with his lower leg flexed and elevated by soft stirrups. He underwent a robot-assisted radical cystectomy in lithotomy position. He had a medical history of urinary tract cancer, type 2 diabetes mellitus, hypertension, and Hashimoto’s disease. The patient was a 50-year-old male, 173 cm tall, and 85 kg in weight (body mass index (BMI): 27.7 kg/m 2). ![]() Only anterior and lateral compartments were affected and successfully treated with single-incision fasciotomy. Here, we report the case of bilateral WLCS following the surgery in lithotomy position. Although two-incision technique to release all four compartments is recommended, fasciotomy itself is associated with a high incidence of acute and long-term complications. A prompt diagnosis and surgical intervention is necessary because the delay of treatment could cause irreversible muscle necrosis which results in limb dysfunction or amputation. The overall incidence is estimated at 1 in 3500 cases however, only less than 25 bilateral WLCS cases have been previously reported. Well leg compartment syndrome (WLCS) is a rare but severe complication after the surgery in lithotomy position. An early and accurate diagnosis is important to avoid the delay of treatment and development of neuromuscular dysfunction. The patient was treated successfully without any neuromuscular dysfunction. Emergent single-incision fasciotomy was performed four hours after diagnosis. Physical examination, elevated serum creatine kinase value, contrasting computed tomography, and elevated compartment pressure strongly suggested the development of bilateral WLCS localized in the anterior and lateral compartments. A 50-year-old man complained of severe bilateral lower leg pain and swelling sixteen hours after the surgery. We present a case of bilateral WLCS that occurred after the prolonged urologic surgery in lithotomy position.
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