Poisoning-induced acute atraumatic compartment syndrome

Acute Atraumatic Compartment Syndrome (AACS) can be a potentially life and limb threatening complication of either drug abuse or medication injection. Prompt recognition followed by emergency fasciotomy is required to avoid p ermanent disability. A better understanding of the different clinical prese ntations may lead to improved outcomes through more expedient diagnosis and treatment. We describe five new cases of AACS caused by illicit drug abuse within the McGill University Hospitals, with a review of all 102 similar p atients previously documented in the literature between January 1970 and Ma y 1997, The average age for all cases was 29 years, with 74% being male. Th e presence of edema, pain, tension, and skin changes were the most frequent symptoms and signs reported. There appear to be two distinct mechanisms of poisoning-induced AACS: (1) direct vasotoxicity and (2) limb compression c aused by prolonged comatose state. Direct vasotoxicity is more likely to le ad to eventual amputation, whereas prolonged limb compression is more likel y to progress to systemic complications such as azotemia, hypotension, card iac arrhythmia, and renal failure (Crush Syndrome). Long-term sequelae of m otor loss, sensory disruption, and development of contracture were common i n AACS of both causes. Because Compartment Syndrome is a surgical emergency , primary care and emergency physicians must have a high index of suspicion to promptly recognize and treat this problem. Copyright (C) 2000 by W.B. S aunders Company.