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1124 - From Intestine to Limb: Peripheral Compartment Syndrome as a Sequelae of Stool Impaction

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

HW

Holly Ward, BS

Medical Student
Carolinas Rehabilitation / Ohio University Heritage College of Osteopathic Medicine
Sandusky, Ohio, United States

Co-Author(s)

TP

Thomas G. Powell, DO

Resident
Carolinas Rehabilitation
Charlotte, North Carolina, United States
TT

Tobias J. Tsai, MD

Medical Director, Pediatric Rehabilitation
Carolinas Rehabilitation / Levine Children's Hospital
Charlotte, North Carolina, United States

Case Diagnosis: Peripheral compartment syndrome as a sequelae of stool impaction

Case Description: A 14-year-old female with a history of cloacal malformation status post repair, cecostomy and VATER (vertebral/anorectal/tracheoesophageal/renal anomalies) association required a daily bowel regimen including oral laxatives, suppositories, and enemas. Prior to admission, she was non-adherent with this regimen. She presented with five days of abdominal pain, encephalopathy, and bilateral leg pain. Imaging demonstrated large stool burden, 8x10x20 cm. Exam showed duskiness of bilateral lower extremities with absent posterior tibial pulses. Ultrasonography identified femoral thrombi obstructing flow from the right posterior tibial and left anterior tibial veins. This prompted anticoagulation, bilateral four-compartment fasciotomies for compartment syndrome, and surgical disimpaction. Upon admission to inpatient rehabilitation, she required close supervision for functional mobility, ambulation, and transfers. Psychology was consulted for coping deficits and poor bowel regimen adherence. Her bowel regimen was adjusted. Upon discharge, she was functionally independent and ambulated with bilateral AFOs.

Discussions: Patients with a chronic disease requiring vigilant medical management are prone to less consistency with disease-specific care as they transition into adolescence. Those with bowel dysfunction are at risk for constipation, and non-adherence to a regular bowel regimen can lead to life- and limb-threatening consequences. This is the first report of lower extremity compartment syndrome due to impaction. Either stool mass effect or increased abdominal pressure can compress nearby vasculature, resulting in blood stasis and thrombus formation. A multidisciplinary team, led by physiatry with pediatric psychology support, was instrumental in safely restoring function and advancing independence.

Conclusions: The case illustrates severe complications of bowel dysfunction, and highlights challenges associated with progressing independence during adolescence. Working with patients, families, and other specialties, the physiatrist is uniquely suited to guide care and optimize outcomes.