Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000400009
Brazilian Journal of Anesthesiology
Clinical Information

Rabdomiólise por síndrome compartimental glútea após cirurgia bariátrica: relato de caso

Rhabdomyolysis secondary to gluteal compartment syndrome after bariatric surgery: case report

Márcio Luiz Benevides; Rubens Jardin Nochi Júnior

http://dx.doi.org/10.1590/S0034-70942006000400009 Braz J Anesthesiol, vol.56, n4, p.408-412, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: A cirurgia bariátrica tornou-se rotineira e muitas complicações têm sido relatadas. O objetivo deste relato foi apresentar um caso de síndrome compartimental glútea que evoluiu para insuficiência renal aguda após cirurgia bariátrica e discutir aspectos do diagnóstico e condutas profilática e terapêutica. RELATO DO CASO: Paciente do sexo masculino, 42 anos, branco, índice de massa corporal (IMC) 43, estado físico ASA II, submetido à cirurgia bariátrica tipo duodenal switch, sob anestesia geral associada à anestesia peridural. O procedimento transcorreu sem intercorrências. O tempo anestésico-cirúrgico foi de 3 horas e 30 minutos. No primeiro dia do pós-operatório o paciente apresentou dor na região lombossacral e nas nádegas, além de parestesia nos membros inferiores na distribuição do nervo isquiático. Durante o exame, as nádegas apresentavam discreta palidez, tensas, edemaciadas, dolorosas à palpação e à movimentação. Foi diagnosticada síndrome compartimental glútea que evoluiu com rabdomiólise e insuficiência renal aguda. Houve recuperação da função renal e nenhuma seqüela motora ou sensitiva foi detectada. CONCLUSÕES: Os pacientes obesos mórbidos submetidos à cirurgia bariátrica podem apresentar síndrome compartimental glútea. Quando não diagnosticada e tratada precocemente, podem evoluir com rabdomiólise e insuficiência renal aguda que representam grave ameaça à vida.

Palavras-chave

CIRURGIA, Bariátrica, COMPLICAÇÕES, DOENÇAS, Obesidade mórbida

Abstract

BACKGROUND AND OBJECTIVES: Bariatric surgery has become a common procedure and several complications have been reported. The objective of this report is to present a case of gluteal compartment syndrome that evolved to acute renal failure after bariatric surgery and to discuss the diagnosis, and the prophylactic and therapeutic measures. CASE REPORT: A 42 years old male patient, white, with a body mass index (BMI) of 43, physical status ASA II, who underwent bariatric surgery of the duodenal switch type, under general anesthesia associated with epidural anesthesia. There were no complications during the procedure. The anesthetic-surgical procedure lasted 3 hours and 30 minutes. On postoperative day one the patient developed lumbosacral and gluteal pain, besides paresthesia in the lower limbs in the distribution of the sciatic nerve. On physical exam, the buttocks were slightly pale, tight, swollen, and painful to palpation and to movement. A diagnosis of gluteal compartment syndrome was made; it evolved to rhabdomyolysis and acute renal failure. The renal function improved and the patient did not present any motor or sensitive deficits. CONCLUSIONS: Patients with morbid obesity undergoing bariatric surgery may present gluteal compartment syndrome as a complication. When it is not diagnosed and treated promptly, it may evolve to rhabdomyolysis and acute renal failure, which represents a serious life-threatening situation.

Keywords

COMPLICATIONS, DISEASES, Morbidity obesity, SURGERY, Bariatric

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