# Acute compartment syndrome due to skeletal muscle metastases from poorly differentiated upper gastrointestinal adenocarcinoma: a case report

## TL;DR

A rare case of upper gastrointestinal cancer causing leg swelling and kidney damage through muscle metastasis is reported, highlighting the need for early detection and interdisciplinary care.

## Contribution

This case report presents a rare presentation of upper gastrointestinal adenocarcinoma manifesting as acute compartment syndrome and acute kidney injury.

## Key findings

- A 52-year-old male presented with nontraumatic acute compartment syndrome caused by skeletal muscle metastasis from poorly differentiated upper gastrointestinal adenocarcinoma.
- The patient developed acute kidney injury due to myonecrosis-induced cast nephropathy.
- The case underscores the importance of considering metastatic disease in nontraumatic acute compartment syndrome.

## Abstract

Acute compartment syndrome (ACS) is characterized by increased pressure within the fascial network of any muscle, leading to impaired circulation and potential myonecrosis. Very rarely, soft tissue infiltration by metastatic disease can cause localized swelling that increases intercompartmental pressures. We report an unusual case of invasive, poorly differentiated upper gastrointestinal adenocarcinoma presented by acute compartment syndrome of the lower extremity and subsequent acute kidney injury (AKI) caused by myonecrosis-induced cast nephropathy.

A 52-year-old male presented to the hospital with rapid onset unilateral right leg pain and tense edema accompanied by myonecrosis with no explicable etiology complicated by AKI. Surgical fasciotomy and subsequent muscle biopsy yielded poorly differentiated non-small cell adenocarcinoma. CT imaging identified diffuse adenopathy along with abnormal thickening of the distal esophagus, gastroesophageal (GE) junction, and gastric cardia. Further investigation via upper esophagogastroduodenoscopy (EGD) revealed an exophytic mass in the distal esophagus extending into the stomach. This lesion was confirmed via biopsy as primary invasive poorly differentiated upper gastrointestinal (UGI) adenocarcinoma.

This case highlights the need for clinicians to implement high-risk screening for UGI cancers and consider skeletal muscle metastasis as a cause of nontraumatic ACS. It emphasizes the importance of interdisciplinary collaboration in managing such complex cases and the role of timely surgical and oncological intervention in preventing long-term complications of ACS. Furthermore, it highlights the potential use of more efficient and specific MR imaging techniques to diagnose ambiguous cases of ACS.