Challenges in Diagnosis and Management of Acute Limb Ischemia 30 Days Postpartum in Lithotomy Position: A Case Report from Somalia Leading to Bilateral Lower Limb Amputation

Acute limb ischemia in postpartum women is a rare and severe vascular emergency that can lead to significant complications if not promptly diagnosed and managed. A 31-year-old woman, 30 days postpartum following uncomplicated vaginal delivery in the lithotomy position, presented with bilateral lower limb paralysis and paresthesia There was no history of trauma, falls, or use of assistive instruments during delivery. The patient weighed 65 kg and was 162 cm tall, while the infant had a birth weight of 2.8 kg. Initial suspicion of a neurological condition was later ruled out through imaging, including thoracolumbar MRI and CT angiography, which revealed bilateral arterial occlusions. Despite timely thromboembolectomy, the patient underwent bilateral below-knee amputation due to progressive ischemia. This case highlights the diagnostic challenges of acute limb ischemia in postpartum patients, stressing the crucial role of early imaging and prompt multidisciplinary intervention in preventing severe outcomes. Increased clinical vigilance and timely investigations are vital for improving prognosis and reducing the risk of limb loss.