BACKGROUND: @entity5925 is a well-known cause of @entity177 and is most commonly caused by @entity63 /reperfusion or @entity130 . We describe a new cause of this syndrome in a series of 6 @entity1 who underwent @entity39 of the gluteal muscles after bariatric surgery, 3 of whom eventually died of @entity177 . METHODS: Potential etiologic factors were studied by comparing these @entity1 with a consecutive series of 100 @entity1 undergoing primary uncomplicated bariatric surgery during a 1-year period. Demographics, preoperative BMI, co-morbidities, duration of operation, and postoperative @entity1011 phosphokinase (CPK) levels. RESULTS: All @entity1 presented with an area of buttock skin breakdown initially diagnosed as a simple decubitus @entity1066 . All had extensive myonecrosis of the medial gluteal muscles requiring extensive debridement. 5 of the 6 @entity1 were male, with median BMI 67 compared with a median BMI 55 in the control group (P=0.0022). The @entity1 were on the operating-room table for a median of 5.7 hours compared with 4.0 in the control group (P=0.01). 3 of the 6 developed @entity177 requiring dialysis, which was fatal in all. One other @entity1 developed a transient elevation of BUN and @entity1011 which did not require dialysis. Since recognition of this pattern, we now routinely perform serial CPK measurements. Median CPK rise in uncomplicated @entity1 was to 1,200 mg/dl (SD 450-9,000), while CPK in affected @entity1 ranged from 26,000 to 29,000 IU/l. We now routinely add additional buttock padding in @entity28 @entity1 and institute aggressive hydration and @entity2656 diuresis if CPK rises above 5,000. No cases have occurred in the past 18 months in 220 @entity1 . CONCLUSIONS: This is an important and potentially fatal complication of bariatric surgery. @entity28 male @entity1 with prolonged surgery are at risk of @entity121 with consequent @entity177 , which we hypothesize is due to pressure by the operating-table leading to @entity5925 and the creation of a @entity2054 . Prevention may be aided by attention to intraoperative padding and positioning, and by limiting the duration of the operation.

@entity121 leading to @entity177 : a potentially fatal complication of surgery in the morbidly XXXX .

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity2656 :: ('MESH:D008353', 'Chemical') :: ['mannitol'] @entity28 :: ('MESH:D009765', 'Disease') :: ['very obese', 'Very obese'] @entity63 :: ('MESH:D007511', 'Disease') :: ['ischemia'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis'] @entity1066 :: ('MESH:D014456', 'Disease') :: ['ulcer'] @entity177 :: ('MESH:D051437', 'Disease') :: ['renal failure'] @entity5925 :: ('MESH:D012206', 'Disease') :: ['Rhabdomyolysis', 'rhabdomyolysis'] @entity2054 :: ('MESH:D003161', 'Disease') :: ['compartment syndrome'] @entity1011 :: ('MESH:D003404', 'Chemical') :: ['creatinine'] @entity121 :: ('MESH:D009135', 'Disease') :: ['gluteal muscle necrosis'] @entity130 :: ('MESH:D014947', 'Disease') :: ['crush injury']
@entity28 :: (MESH:D009765,Disease) :: ['obese']
