Emergent Fasciotomy for Acute Compartment Syndrome Following Contrast Media Extravasation: A Case Report

Abstract

Background Contrast media (CM) extravasation is a rare complication of imaging procedures, usually benign but occasionally progressing to acute compartment syndrome (ACS), a limb-threatening emergency requiring prompt surgical decompression. Case Presentation A 47-year-old woman with pancreatic cancer and type I diabetes developed severe left hand swelling, pain, and numbness following a CT angiogram. Imaging revealed extensive CM extravasation throughout the forearm and wrist. Emergent fasciotomy revealed tense, edematous compartments with expression of extravasated contrast, consistent with ACS; compartment pressures were not formally measured. Staged wound management included negative pressure wound therapy, Restrata synthetic sheath application, and autologous skin grafting. A return to the OR at 48 hours was delayed due to the patient suffering an acute anxiety attack, however the patient ultimately regained significant motor and sensory function. Discussion and Conclusion This case underscores the potential for ACS following CM extravasation and the critical importance of early recognition. Literature suggests no universal consensus on optimal fasciotomy closure, highlighting the need for comparative studies to establish evidence-based guidelines.