A case of reflex sympathetic dystrophy following an emergency abdominal operation
Sato, S.; Endo, T.; Koyama, K.; Fukuda, T.; Naito, H.
Masui. Japanese Journal of Anesthesiology 37(12): 1547-1551
1988
ISSN/ISBN: 0021-4892 PMID: 3236405 Document Number: 325571
Reflex sympathetic dystrophy of the upper extremity, or shoulder hand syndrome, is a neurovascular condition affecting the shoulder and hand. Pain, swelling, vasomotor disturbances, restricted range of motion, and impaired function are important manifestations. This syndrome normally follows trauma or surgery to the affected extremity. We report a rare case of this syndrome which occurred after abdominal surgery. Emergency subtotalgastrectomy was scheduled for a patient with duodenal perforation. He was intubated after crash induction and the course of anesthesia was uneventful. Eight days after the operation, the patient complained of moderate burning pain in the left shoulder with hand swelling. Because of the hand swelling and pain, it was difficult for him to make a fist. His X-ray finding of cervical vertebrae showed narrowing of left intervertebral foramen at C5 and C6. We suspected that the cause of reflex sympathetic dystrophy in this patient is the cooperative action of the narrowed cervical inervertebral space and cervical extension during the endotracheal intubation. Moreover, we could not neglect the possibility of the involvement of intravenous catheter and intra-muscular injection carried out on the same extremity.