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What Causes Oedema In Leg After The Surgery For Bladder Stones?
Question: Hi Doc,
My father had recently gone with surgery for bladder stones in the month on Nov 2014, although this process is complete, he developed issues with his right leg.
The right Leg is completely senseless and immobile immediately after the surgery.
The bladder stones process took about 40 mins time and during this time he was given spinal anesthesia. (His leg was automatically lifted all by itself in lying down postion without his knowledge during the surgery)
After the surgery the doctor recommended Brain & Spine MRI to figure out something wrong there and the reports were normal, so the source of Brain & Spine is ruled out.
The doctors recommended physiotherapy on leg and to see any progress, so we immediately started with physio therapist, he regained 30-40% senses and strength on his leg and was able to walk with help of walking stick after almost 2 months from the time of surgery.
(At one point he felt so senseless that he burnt his leg while using hot pack because of lack of sensation)
After this time he went to his home town in car (8-10 hrs journey) and he started resuming Physiotherapy, however after few days he developed some few blackspots and leg is swollen completely from the ankle, lower limb and the thigh area.
Physiotherapist suspected infection and stopped his process, we immediately consulted neurosurgeon, he suggested doppler test on the leg and suspected some clots.
We immediately bought him back to our city and referred to neurosurgeon, he after checking the case history and sequence events, suspected a case of clots in the veins and suspected a case of Deep vein thrombosis (DVT) and referred to Vasular Surgeon, vasco surgeon after the checking the case referred to veins & arteries doppler tests along with few blood tests.
I have attached these latest reports for your referral.
The results are not conclusive, please check the reports and let me know what could be wrong and what options we have.
Patient Details:
Age: 61
Sex: Male
Weight: 92 kg (was 100 kg during surgery)
Height: 5' 7"
Diabetic & H Blood pressure
Current Status:
Complains burning sensation in leg
Pains right upto chest while trying to walk with walker
Doctor recommended walking with stocking on to avoid fluid formation
Damaged knee/Arthiritis was found after surgery (No issues prior)
Advised to contact again neurologist again.
Regained 30-40 % senses, swelling reduced a bit, however not able to walk due to reduced strength and sense and swelling.
Kindly review the case in detail and advise as appropriate.
Regards,
XXXX
My father had recently gone with surgery for bladder stones in the month on Nov 2014, although this process is complete, he developed issues with his right leg.
The right Leg is completely senseless and immobile immediately after the surgery.
The bladder stones process took about 40 mins time and during this time he was given spinal anesthesia. (His leg was automatically lifted all by itself in lying down postion without his knowledge during the surgery)
After the surgery the doctor recommended Brain & Spine MRI to figure out something wrong there and the reports were normal, so the source of Brain & Spine is ruled out.
The doctors recommended physiotherapy on leg and to see any progress, so we immediately started with physio therapist, he regained 30-40% senses and strength on his leg and was able to walk with help of walking stick after almost 2 months from the time of surgery.
(At one point he felt so senseless that he burnt his leg while using hot pack because of lack of sensation)
After this time he went to his home town in car (8-10 hrs journey) and he started resuming Physiotherapy, however after few days he developed some few blackspots and leg is swollen completely from the ankle, lower limb and the thigh area.
Physiotherapist suspected infection and stopped his process, we immediately consulted neurosurgeon, he suggested doppler test on the leg and suspected some clots.
We immediately bought him back to our city and referred to neurosurgeon, he after checking the case history and sequence events, suspected a case of clots in the veins and suspected a case of Deep vein thrombosis (DVT) and referred to Vasular Surgeon, vasco surgeon after the checking the case referred to veins & arteries doppler tests along with few blood tests.
I have attached these latest reports for your referral.
The results are not conclusive, please check the reports and let me know what could be wrong and what options we have.
Patient Details:
Age: 61
Sex: Male
Weight: 92 kg (was 100 kg during surgery)
Height: 5' 7"
Diabetic & H Blood pressure
Current Status:
Complains burning sensation in leg
Pains right upto chest while trying to walk with walker
Doctor recommended walking with stocking on to avoid fluid formation
Damaged knee/Arthiritis was found after surgery (No issues prior)
Advised to contact again neurologist again.
Regained 30-40 % senses, swelling reduced a bit, however not able to walk due to reduced strength and sense and swelling.
Kindly review the case in detail and advise as appropriate.
Regards,
XXXX
Brief Answer:
Varicose veins/Arthritis/lymphedema may be the factors causing edema.
Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through your father's detailed history and medical records uploaded by you.
Your father's right leg weakness after the bladder surgery was most likely due to proximal neuropathy-probably sciatic neuropathy,as it is common in this type of clinical setting,due to some injury to sciatic nerve either during surgery or regional anesthesia.MRI Brain and Spine will show no abnormality in such a case,as in this case.
However,if Nerve conduction studies(NCS) of lower limbs are done,the results of NCS can be diagnostic of proximal neuropathy.So,I would suggest to please let him undergo Nerve conduction studies in order to make the primary diagnosis.
Regarding the swelling in right lower limb that has developed later,we have a few strong possibilities here-
1)Varicose veins-Right lower limb venous doppler has shown that right lower limb has varicose veins and below knee perforators are incompetent,so this is surely contributing to the swelling.
2)Gross knee arthritis can be producing signs of inflammation and hence swelling,at least,in some region around the knee joint.
3)Please undergo testing for lymphedema causes,most commonly-Filariasis,as it is a common cause of edema in a single lower limb.At the same time,please get evaluated for lymphadenopathy-whether inguinal lymph nodes are significantly enlarged or not?Lymphadenopathy favours lymphedema.
Meanwhile,please follow these steps for further management-
1)General surgeon's opinion on varicose veins.
2)Rheumatologist's opinion for knee joint arthritis management.
3)Lymph nodes avaluation by a physician and filaria testing.
4)Strict blood sugar management.
Steps 1,2,3 and 4 may be of help in tackling the swelling in lower limb.
Further,Please follow up with Nerve conduction studies of lower limbs so that primary diagnosis can be established.
Hope I have answered your query.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Varicose veins/Arthritis/lymphedema may be the factors causing edema.
Detailed Answer:
Hi XXXXXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
I have gone through your father's detailed history and medical records uploaded by you.
Your father's right leg weakness after the bladder surgery was most likely due to proximal neuropathy-probably sciatic neuropathy,as it is common in this type of clinical setting,due to some injury to sciatic nerve either during surgery or regional anesthesia.MRI Brain and Spine will show no abnormality in such a case,as in this case.
However,if Nerve conduction studies(NCS) of lower limbs are done,the results of NCS can be diagnostic of proximal neuropathy.So,I would suggest to please let him undergo Nerve conduction studies in order to make the primary diagnosis.
Regarding the swelling in right lower limb that has developed later,we have a few strong possibilities here-
1)Varicose veins-Right lower limb venous doppler has shown that right lower limb has varicose veins and below knee perforators are incompetent,so this is surely contributing to the swelling.
2)Gross knee arthritis can be producing signs of inflammation and hence swelling,at least,in some region around the knee joint.
3)Please undergo testing for lymphedema causes,most commonly-Filariasis,as it is a common cause of edema in a single lower limb.At the same time,please get evaluated for lymphadenopathy-whether inguinal lymph nodes are significantly enlarged or not?Lymphadenopathy favours lymphedema.
Meanwhile,please follow these steps for further management-
1)General surgeon's opinion on varicose veins.
2)Rheumatologist's opinion for knee joint arthritis management.
3)Lymph nodes avaluation by a physician and filaria testing.
4)Strict blood sugar management.
Steps 1,2,3 and 4 may be of help in tackling the swelling in lower limb.
Further,Please follow up with Nerve conduction studies of lower limbs so that primary diagnosis can be established.
Hope I have answered your query.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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