Far-Eastern Memorial Hospital, Taiwan
Posters & Accepted Abstracts: Prim Health Care
Maintaining the lithotomy position and the operation time is more than 2-4 hours; it may cause swelling and pain of the lower extremity due to acute compartment syndrome and deep vein embolism. A 65-year-old man suddenly left lower extremity swelling and pain after undergoing 6 hours of colon cancer surgery in the lithotomy position. After a detailed evaluation, with the physical examination and laboratory test results, exclude acute compartment syndrome and deep vein thrombosis. The history of gout was confirmed in repeated interrogation, clinical symptoms are sudden left lower limb swelling and pain, redness and gradually confined to the left knee joint, high serum uric acid levels and the left knee X-ray showing supra-patellar pouch with a product of synovial fluid. The clinical symptoms consistent with 2015 ACR and the European Union Rheumatology (European League Against Rheumatism, EULAR) diagnostic criteria for gout, gout was diagnosed. In accordance with the principles of the treatment of gout, give NSAIDs and uric acid lowering drugs, rest, ice packing and hydration, symptoms relieve within a week. In the literature, it was found that dehydration and insufficient water intake are one of the causes of acute gout. This case is in the process of preparing for colon cancer surgery, fasting before surgery, diarrhea caused by bowel preparation, water intake is not enough and intravenous fluid replacement is inadequate, these factors make acute gout triggered. Based on this experience, recommended gout cases before undergoing bowel surgery, at the same time as the bowel cleansing preparation, amount of input and output should be monitored, according to the monitoring results, via intravenous infusion of appropriate, to ensure that the body of fluids is enough, uric acid is excreted by the kidneys, reduce the acute episode of gout is triggered, prevents delayed recovery of gastrointestinal function.