Hanging from the Bathroom Window

Some time ago, I posted a story called Dancing with the Stars. http://badtadmd.com/dancing-with-the-stars/

In that story, a young man hung himself upside down, on purpose, to “dance.” The stress on his leg caused widespread breakdown of the leg muscles. This is a concern to us in the ED because damaged muscle cells cause proteins to leak into the blood stream. A high concentration of these proteins is toxic to the kidneys and can cause kidney failure. This condition is called rhabdomyolysis.

Here is another story that is bizarrely similar:

Hanging from the Bathroom Window

An 88-year-old woman was found hanging by her legs out of the bathroom window. She was unable to say what happened to her, but those who found her believed she may have been there all night.

When she arrived, she was very confused, dehydrated and both of her legs were swollen, discolored, and tender. A bone in one leg was broken, but that was the least of her problems. She had two very serious complications of having prolonged stress on her leg muscles. Like the “upside down dancer,” this woman had rhabdomyolysis and the risk of kidney failure. She also had a compartment syndrome in both of her lower legs.

A compartment syndrome of the leg develops when there is damage to leg muscles, which are bundled in compartments made of strong fibrous bands. The damaged muscles tend to swell but the fibrous bands prevent the compartments for enlarging.  This leads to increased pressure in the compartment. If this is not identified and treated, blood is unable enter the compartment and the muscles can actually die from lack of blood supply.

The treatment for a compartment syndrome is called a fasciotomy. Long cuts are made through the skin and the fibrous bands so the muscles have room to swell. These cuts are left open until the muscles heal. The defects can later be closed with skin grafts. This lady required fasciotomies in both of her lower legs before she was admitted to intensive care.

Here is a picture I snagged from the Internet that shows what a fasciotomy of the leg looks like:

And here is one from our son-in-law’s brother’s fasciotomy:

And Wikipedia links for the same:

https://en.wikipedia.org/wiki/Compartment_syndrome

https://en.wikipedia.org/wiki/Fasciotomy