A Rare Case Report of Retrograde Air Embolism and Phenytoin Extravasation Causing Acute Superficial Venous Thrombosis and Purple Glove Syndrome of the Upper Limb.
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
Background: 26-Year-old female patient admitted with pseudocyst of pancreas with systemic lupus erythematosus,Evans syndrome,known case of epilepsy on treatment was admitted for Elective cystogastrostomy. Postoperatively patient was on IV Phenytoin infusion. On postoperative day 3 patient developed sudden Purple glove syndrome of the left upper limb within 15 minutes of IV phenytoin infusion. On examination at 15 mins patient had deep blue cyanosed left hand with cold clammy hand and forearm. Patient complained of excessive pain in the hand and forearm. Radial artery pulsations were feeble. Within 30 mins of the incident patient developed wrist drop and sensory loss extending till the elbow. Capillary refill was not appreciated in the hand. Doppler ultrasound revealed cephalic and basilica vein thrombosis with biphasic waveform of the arteries of the upper limb with shouldering on systolic downstroke. Emergency vascular surgery consult was taken and conservative line of management with IV heparin, Dextran, nifidipine was started. Patient had to undergo 13 serial fasciotomies for compartment syndrome of the upper limb. Patient also had bone marrow failure on day 2 due to predisposing Evans syndrome and lupus. Here is one case where a routine elective abdominal procedure became a nightmare for the surgeon. Later complete recovery and hand function was achieved.
Authors and Affiliations
Dr. Siddharth Vijay Kalke
Keywords
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