LAUSR

We report the rare simultaneous presence of compartment syndrome of abdomen, tibia and gluteal region, in a 24-year-old heroin abuser after an injection performed direct into his right tibia muscles and sitting in a chair, for 10 h approximately. He presented to the emergency department complaining of stomach ache, nausea, vomiting and pain of his both legs. Foot drop associated with weak plantar flexion of right leg and foot drop accompanied with weak thigh flexion, ankle eversion or inversion, plantar flexion or dorsiflexion and toe movements of left leg were also obviously evidenced. The abdomen was tensely distended with diffuse tenderness and rebound tenderness. Bowel sounds were hypoactive. His arterial blood pressure was 90/55 mmHg, his respiratory rate 22/min, his body temperature 38.2 C and his central venus pressure was 22 cmH2O. Indirect measurement of intra-abdominal pressure through the urinary bladder revealed a pressure of 31 mmHg. Laboratory results showed rhabdomyolysis with impaired renal function and acute pancreatitis. A computed tomography scan of abdomen was performed and showed acute pancreatitis. The echo demonstrated oedema of right gastrocnemius muscle. A diagnosis of compartment syndrome of abdomen, tibia and gluteal region was made, involved right peroneal and tibial nerve and left schiatic nerve. Urgent surgical decompression (abdomen, tibial and gluteal region) was performed, to avoid multiple organ failure and leg amputation. The patient discharged to home in stable condition after 18 days. Unfortunately, he died of heart attack episode due to heroin overdose, after 4 months. Heroin addiction is known to cause various medical complications, such as rhabdomyolysis and compartment syndrome. Peripheral nerves may sometimes be injured during unconscious states, following heroin abuse and rhabdomyolysis, especially when the patient develops compartment syndrome. Under other circumstances, rhabdomyolysis and acute pancreatitis may lead to abdominal compartment syndrome, which is a life-threatening condition. Physicians should always keep in mind the possibility of abdomen compartment syndrome and not only focus on obvious leg compartment syndrome in cases of heroin abusers.