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Two cases of unidentified acute compartment syndrome
  1. Shinsuke Takeda1,2,
  2. Masahiro Tatebe2,
  3. Atsushi Sakai3,
  4. Hitoshi Hirata2
  1. 1Hand and Microsurgery Center, Anjo Kosei Hospital, Anjo, Japan
  2. 2Department of Hand Surgery, Nagoya University, Nagoya, Japan
  3. 3The Japan Snake Institute, Ota, Japan
  1. Correspondence to Dr Shinsuke Takeda, s7.takeda.jpn{at}


Acute compartment syndrome (ACS) is a surgical emergency that requires urgent fasciotomy to prevent irreversible sequelae. We report two cases of unidentified ACS, which did not result from traumatic injuries such as fractures or crush injury, iatrogenic injury or diseases such as haematological malignancies. Both patients complained of severe pain and swelling of their extremity. No bite marks, blisters or skin necrosis was noted. They also complained of marked symptoms of third cranial nerve injury, including divergent squint and diplopia. The diagnosis of ACS was made following continuous intracompartmental pressure measurement, and both patients underwent urgent fasciotomy with partial incision. Considering the season and location of the injuries, together with the rapid progression of signs and symptoms that included thrombocytopaenia, acute renal failure, rhabdomyolysis and especially that of third cranial nerve injury, we postulate that these two cases may have developed following mamushi (Gloydiusblomhoffii) bites.

  • orthopaedic and trauma surgery
  • emergency medicine

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  • Contributors Drafting the article: ST. Revising it critically for important intellectual content: MT, AS. Final approval of the version to be submitted: HH.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.