An unexpected case of neonatal compartment syndrome associated with congenital anomalies of kidney and urinary tract

被引:0
作者
Seske, Laura M. [1 ]
Mastroianni, Melissa [2 ]
Aziz, Keith T. [3 ]
Lewallen, Laura W. [4 ]
机构
[1] Johns Hopkins Sch Med, Dept Pediat, Div Neonatol, Chicago, IL USA
[2] Johns Hopkins Univ, Dept Plast & Reconstruct Surg, Baltimore, MD USA
[3] Johns Hopkins Univ, Dept Orthopaed Surg, Baltimore, MD USA
[4] Univ Chicago, Dept Orthopaed Surg & Rehabil Med, 5841 S Maryland Ave,RM P-211,MC 3079, Chicago, IL 60637 USA
关键词
acute compartment syndrome; desquamation; ischemia; neonatal compartment syndrome; ISCHEMIC CONTRACTURE;
D O I
10.1515/crpm-2022-0020
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
Objectives Neonatal compartment syndrome (NCS) occurs when increased pressure within the fasciocutaneous compartment decreases capillary perfusion, causing irreversible tissue damage from ischemia. NCS is a rare condition that requires prompt diagnosis and treatment. Diagnosing NCS is highly dependent on the examination, which can be difficult in newborns. Prompt recognition provides the best chance for good outcomes.Case presentation We present a case of NCS diagnosed and treated based on physical examination findings. Fetal ultrasonography showed bladder distension, bilateral hydroceles, urethra dilation, and abdominal urinary ascites concerning for lower urinary tract obstruction and possible bladder rupture. At 1 h after birth, examination of the infant's left upper extremity showed no spontaneous movement, the hand and forearm appeared dusky, and the hand had a large blister with desquamation. No pulse distal to the antecubital fossa was detected via Doppler ultrasonography. The infant was diagnosed with NCS and underwent urgent fasciotomy. The clinical appearance and perfusion of the left upper extremity gradually improved. At four months of age, the wounds were healed and the patient had full passive range of motion of the left upper extremity. Recovery of active motion is ongoing.Conclusions The presence of blistering and desquamation should provoke suspicion for NCS. Once NCS is diagnosed, prompt intervention is necessary to reduce the risk of poor functional outcomes. This case highlights the need for increased awareness of the risk developing compartment syndrome in utero as part of the rare sequalae in infants with congenital anomalies of kidney and urinary tract.
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