We report two cases complicated with lower limb compartment syndrome after surgery for rectal tumor in the lithotomy position. Case 1: A 61-year-old man underwent laparoscopic low anterior resection for the rectal cancer. The position used was the crushed stone position and the lower limbs were fixed using the boot type of fixture, with the intraoperative head low, and the right side low[MS1]. Operative time was 6 hours and 25 minutes. From the first postoperative day, the patient suffered spontaneous pain and swelling of the left lower leg, with numbness of the posterior tibial nerve, saphenous nerve area, and weakness of ankle-plantar flexors. Contrast CT showed swelling and a low-density area of the left medial muscle in the lower limbs. Serum CK was >10,888IU/L, compartment pressure was >22mmHg. We diagnosed this as compartment syndrome, which was confined to the superficial [MS2] area of the back side of the left lower leg, and performed fasciotomy on the same day. After surgery he was discharged without sequelae. Case 2: A 60-year-old man underwent abdominoperineal resection for rectal GIST. The fixed posture and lower extremity position was the same as in Case 1. Operative time was 4 hours and 50 minutes. The patient had spontaneous pain and swelling of the left thigh to lower leg immediately after the surgery. At 5 hours postoperatively the lower leg swelling was exacerbated, serum CK was 30,462IU/L, and compartment pressure was >60mmHg. We diagnosed this as a left lower leg compartment syndrome. He underwent fasciotomy on the same day. After surgery the left lower leg was nimble [MS4]without sequelae. Rectal surgery is often performed in the lithotomy position. Therefore, it is necessary to carefully consider the possibility of the onset of lower limb compartment syndrome resulting from the lower leg pressure. Upon onset, this is a complication that may leave severe dysfunction, and thus the lithotomy position should be fixed with sufficient care. When it develops, it is necessary to take early appropriate action. From these clinical experiences in our operating room, we have introduced a new standard at the time of lithotomy position surgery; similar complications have not been observed after its introduction. We also include those details.
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