A 69-year-old man with rectal cancer underwent laparoscopic anterior resection of the rectum. The operative position was the lithotomy position with his head placed to the lower right in the Trendelenburg position. His lower legs were fixed with a supportive device. Postoperatively, he complained of left lower limb pain and severe swelling and tenderness were observed. On the first postoperative day there was more severe swelling in the left lower limb swelling and he experienced a slight motor and sensory disturbance of the dorsum of the foot. At first, we suspected deep venous thrombosis, but Doppler ultrasound examination was negative. Enhanced computed tomography revealed the left lower limb muscle to be massively swollen and edematous in the posterior compartment. Acute arterial occlusion and deep venous thrombosis were also not found. The serum creatine kinase value was 56,604 IU/L. The compartment pressure of the left gastrocnemius muscle was 110 inmHg. We diagnosed severe compartment syndrome of the left lower limb and performed fasciotomy via the double incision dorsal approach. The patient recovered, but slight sensory disturbance of the dorsum of the foot remained. Lower limb compartment syndrome after laparoscopic colorectal surgery in the lithotomy position is a rare but serious complication possibly resulting in severe sequelae. Laparoscopic surgeons should be aware of pre-ventative measures to reduce the incidence of lower limb compartment syndrome. However, if suspected, timely diagnosis and prompt fasciotomy are crucial for a favorable outcome.
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