A Rare Case of Gluteal Compartment Syndrome and Rhabdomyolysis After Robotic-Assisted Partial Nephrectomy

Gluteal compartment syndrome (GCS) is a rare but serious condition involving high intra-compartmental pressures that can result in rhabdomyolysis with tissue ischemia and necrosis. We present the case of a 38-year-old male with class III obesity who was positioned in lateral decubitus for a 4-h long robotic-assisted partial nephrectomy, completed in standard transperitoneal fashion, for a 3-cm renal mass later diagnosed as renal cell carcinoma, chromophobe type. Postoperatively, patient demonstrated clinical picture consistent with GCS, including pain with passive motion, weakness, tea-colored urine, and elevated creatine kinase (CK). He was managed expeditiously with emergent gluteal fasciotomy. Postoperatively, his CK and pain improved and he was discharged on postoperative day 5. At 1-year follow-up, he has normal renal function, no evidence of renal cell carcinoma (RCC) recurrence, and normal neurologic and muscle function. His case demonstrates the need for a high index of suspicion for musculoskeletal complications when operating on severely obese patients.