[Traumatic rhabdomyolysis. A clinical case].

The authors report a case of post-traumatic rhabdomyolysis in a victim of a car accident who, after having being initially examined at an emergency ward, was sent home having been requested to return for a control visit a few days later. The patient did not attend the control visit on the appointed day but returned to the same emergency ward eight days after the accident suffering from vomiting, general malaise and violent pain in the left forearm that appeared swollen. Anamnesis revealed a severe condition of rhabdomyolysis with dehydration, pale red urine and general signs of marked renal insufficiency. Tests showed marked myoglobinemia and myoglobinuria, very high CPK, azotemia, creatinemia, transaminase and high diastasemia. Given the disappearance of peripheral pulse and the severe neurovascular impairment of the left forearm caused by edematous compression, it was decided to proceed to surgical decompression using extensive longitudinal fasciotomy under supraclavicular anesthesia. After surgery peripheral pulse returned to normal, as was confirmed by Doppler. After adequate hydration while renal insufficiency lasted, hemodialysis was commenced immediately and repeated during the following days. Given that all the tests had improved and results were virtually within the norm, the patient was transferred to the medical ward after eight days for continuation of therapy. It is important to underline the importance of possible signs, such as oleguria, dark urine, swelling and edemas of the limbs, in injured patients. If renal insufficiency occurs, it is important to commence early hemodialysis. On day 23 the patient was again transferred to the intensive care ward because he presented epigastric pain and vomiting. CAT showed acute pancreatitis which resolved leading to full recovery after 20 days.