Clinical Diagnosis:

• Newly diagnosed Type 2 Diabetes Mellitus
• Acute Cellulitis of the Left Lower Limb with Impending Compartment Syndrome
• Septicaemia
• Acute Kidney Injury (AKI)
• Acute Hepatitis

Examination Findings:

• General Condition: Conscious, febrile, tachycardia
• Vital Signs: Blood Pressure: 120/70 mmHg
• Left Lower Limb: Swollen up to the knee joint with signs of acute inflammation, edema, tenderness / pain on passive dorsiflexion / planterflexion of left angle joint, toes/Peripheral pulses feeble.

Investigations on Admission:

• Random Blood Sugar (RBS): 257 mg/dL
• Blood Urea: 41 mg/dL (Normal: 15-40 mg/dL)
• Serum Creatinine: 1.3 mg/dL (Normal: 0.8-1.0 mg/dL)
• Serum Bilirubin: 10.5 mg/dL (Normal: 0.2-1.2 mg/dL)
• HbA1c: 8.3%
• Total Leukocyte Count (TLC): 13,400 cells/cumm (P80%, L16%, E4%)
• Hemoglobin (Hb): 13.8 g/dL (Normal: 12-15 g/dL)

 

Doppler Study for Lower Limb:

• Dorsalis Pedi’s Artery: Normal triphasic pattern and flow
• Diagnosis: Cellulitis of the lower limb

 USG Abdomen Findings:

• Bilateral hypoechoic kidneys suggestive of acute kidney injury.

 Prothrombin Time and Clotting Profile:

• Prothrombin Index: 20.2 (Normal: 11.0-15.0)
• INR: 1.62 (Therapeutic INR: 2.0-3.5)
• APTT: 86.2 seconds (Control: 29.5 seconds)

 Final Diagnosis:

1. Impending Compartment Syndrome of the Left Leg
2. Newly Diagnosed Type 2 Diabetes Mellitus
3. Acute Cellulitis with Septicaemia Lt leg
4. Acute Kidney Injury (AKI)
5. Acute Hepatitis
6. Psoriasis – both legs

 Initial Management:

• Broad-spectrum antibiotics and metronidazole were started to manage the infection.
• Insulin was administered for hyperglycemia control.
• IV fluids were provided for hydration.
• Hepatoprotective drugs were initiated for elevated bilirubin levels.

 

Surgical Intervention:

• On Day 3, debridement and fasciotomy of the left leg and foot were performed under spinal anesthesia due to impending compartment syndrome.
• Approximately 200 mL of fluid was drained during the procedure.

 Postoperative Period:

• On the 2nd postoperative day, the wound dressing was soaked  fresh blood, with altered  coagulation profile requiring transfusion with FFP and whole blood on the 2nd, 3rd, and 4th postoperative days. No further active bleeding occurred after these interventions.
• The swelling in the left leg subsided gradually, with significant improvement observed by the 3rd and 4th postoperative days.

 

Laboratory Findings Post-Surgery:

• Total Leukocyte Count (TLC): 11,200 cells/cumm
• Polymorphs: 83%
• Hemoglobin (Hb): 10 g/dL
• Serum Bilirubin: 4.5 mg/dL (improved from 10.5 mg/dL)

Discharge Condition:

The patient was discharged on the 10th day of admission with the following parameters:

• Fasting Blood Sugar (FBS): 108 mg/dL
• Post-Prandial Blood Sugar (PPBS): 182 mg/dL
• Serum Bilirubin: 1.8 mgs%, [normal0.4 -1.2 mgs%]

The swelling in the left leg had reduced significantly, and the patient was stable at discharge.

Medications on Discharge:

• Insulin Injection
• Oral Antibiotics
• Hepatoprotective Drugs
• Wound Care: Wound dressing to be done on alternate days, with follow-up in the OPD.

Impression:

Follow-Up :

•    The wound is completely healed by the 8th week post-surgery.
• The patient has been advised oral hypoglycemic agents (OHA) and proper treatment for diabetes management.

PRE OPERATIVE

DURING SURGERY

3^RD POST OPERATIVE DAY

10^TH POST OPERATIVE DAY

15^TH POST OPERATIVE DAY

After 20 days

After 40 days