Rhabdomyolysis and acute renal failure after bariatric surgery: severe forms of crush injury

Background

Rhabdomyolysis is one of the leading causes of acute renal failure (ARF). The most commonly described crush injury is that which affects victims of natural disasters such as earthquakes, mining or industrial accidents, war, or any other situation resulting in the collapse of buildings and falling debris. It may also affect patients who, because of an altered level of consciousness, crush a part of the body with their own weight, such as after drug overdose or stroke. Surgical positioning is a much less common etiology, with few cases reported in the world literature implicating it as a cause. Among the risk factors for the development of postoperative RML, surgical time and overweight are the most important. A few cases of RML with acute renal failure have been reported in morbidly obese patients having surgery for several reasons, and another few cases recently reported at the same time in patients undergoing gastric bypass [1, 2]. As the number of bariatric procedures by laparotomy or laparoscopy has been growing fast in the past few years, mainly in Western countries, an increasing incidence of this complication may be seen. Besides, in the learning curve of laparoscopic procedures, a longer surgical time (up to 4 or 5 hours) is another risk factor [3]. Strategies to avoid and to treat this complication and the consequences must be applied in all perioperative periods.

Objective

To report a series of six cases (five male, one female) of severe rhabdomyolysis after bariatric surgery from a surgical ICU (14 beds) of a university hospital.

Conclusions

Bariatric surgery, and probably other surgical procedures in morbidly obese patients, is a significant form of crush injury (overweight and prolonged immobilization on the operating table) leading to postoperative rhabdomyolysis (maximum CPK value: 29,150 ± 17,129 IU/l) and reversible myohemoglobinuric acute renal failure (66.6% of cases). Fluid expansion, urine alkalinization and renal replacement therapy are the mainstays of treatment. Cases of complete crush syndrome (hypotension, coagulopathy, acute renal failure) and death (0%) are rare according to our series and the specific literature.