Bilateral rhabdomyolysis after radical hysterectomy in the prolonged lithotomy position: a case report

BACKGROUND: Rhabdomyolysis is a rare but severe complication of surgery. It usually presents as localized pain, swelling, numbness, and muscle weakness in the damaged counterpart and may be accompanied by myoglobinuria and varying degrees of elevated creatinine phosphokinase. CASE PRESENTATION: In this case, a 41-year-old woman, of Han Chinese ethnicity, who underwent laparoscopic radical hysterectomy in the lithotomy position, complained of significant bilateral lower extremity gastrocnemius pressure pain on postoperative day 1. Lower extremity vascular color Doppler ultrasonography revealed a left calf medial gastrocnemius muscle tear with possible hematoma formation. The serum creatine phosphokinase level increased to 7540.9 U/L. Magnetic resonance imaging of both calves revealed symmetrical mass-like abnormal signals with clear borders in the posterior upper calf muscles on both sides. We considered that she might have suffered from rhabdomyolysis and treated her symptomatically, and her condition gradually improved without other complications. CONCLUSION: Although the incidence of intraoperative rhabdomyolysis is not high, it occasionally occurs during surgery in the lithotomy position. It may be asymptomatic or may cause severe symptoms such as AKI and multiple organ dysfunction. Therefore, prompt detection and active management are needed to avoid severe complications in clinical practice.