Lumbar muscle rhabdomyolysis as a cause of acute renal failure after Roux-en-Y gastric bypass.

BACKGROUND

Rhabdomyolysis occurs when injury to skeletal muscle disrupts the integrity of the sarcolemmal membrane, allowing release of intracellular proteins into the circulation. Serious complications, such as hyperkalemia, hypocalcemia, hyperphosphatemia, compartment syndrome, cardiac dysrhythmias, disseminated intravascular coagulation, and acute renal failure can develop if diagnosis and treatment are delayed.

METHODS

A morbidly obese patient is presented who developed this rare complication after Roux-en-Y gastric bypass. Etiology, pathophysiology, complications, diagnosis and treatment are reviewed, to enable prompt treatment.

RESULTS

The patient was treated with crystalloid resuscitation, mannitol, and sodium bicarbonate, and underwent 3 courses of hemodialysis. Normal renal function returned by postoperative day 5.

CONCLUSIONS

Morbidly obese patients are at higher risk for developing postoperative rhabdomyolysis, likely because of increased compressive pressure due to the patient's weight. Surgeons should consider rhabdomyolysis in morbidly obese patients who experience postoperative oliguria. Frequent position changes during operations lasting more than 2 hours can protect muscle tissue from compressive injury.