Postsurgical rhabdomyolysis

Abstract

Introduction: Rhabdomyolysis is an entity that can present as a low-incidence postoperative complication characterized by myonecrosis with release of toxins into the bloodstream. There are predisposing factors and the majority of post-surgical rhabdomyolysis have a multifactorial etiology. It generally presents with acute kidney injury and the need for dialysis, which increases the days of hospital stay and mortality.

Purpose: The purpose of this article is to report on the clinical case of a patient diagnosed with rhabdomyolysis after a surgical intervention, in addition to providing relevant information on early diagnosis and timely treatment.

Case presentation: It is about a 69-year-old male patient who undergoes surgery for shoulder arthroscopy, repair of the rotator cuff due to previous and superior injury, plus biceps tenotomy with subdeltoideal acromioclavicular decompression. During the postoperative period, he presents asthenia, nausea, and 12 hours of anuria. There is evidence of elevation in azotemia and muscle enzymes (Creatine phosphokinase (CPK): 10,519U/L), and the diagnosis of rhabdomyolysis is established. He remains hospitalized with an infusion of crystalloids and furosemide, in addition to steroids (methylprednisolone), N-acetylcysteine, and bicarbonate, without improvement, requiring hemodialysis. Subsequently, he evolves favorably with a gradual decrease in azotemia and muscle enzymes, and is discharged after 14 days of hospitalization.

Discussion and conclusion: Post-surgical rhabdomyolysis is frequently a multifactorial pathology, influenced by predisposing elements directly related to the patient, the surgical process, and drugs. A rare case of multifactorial postsurgical RML is presented in an elderly male patient, considered as risk factors, who required RRT and therefore, it increased hospitalization´s days.