Disclosures: Erin L. Mundy, MD: No financial relationships or conflicts of interest

Case Diagnosis: Lower extremity edema due to IVC compression

Case Description: A 53-year-old male with Marfan’s syndrome presented originally for an abdominal aortic aneurysm repair, whose post-op course was complicated by a pelvic hematoma. On presentation to inpatient rehabilitation, the patient had 4/4 pitting edema to bilateral lower extremities, scrotum, and penis. Medical management and decongestive therapies were ineffective at reducing his edema, which limited his ability to transfer, ambulate, and perform lower body dressing. Follow-up imaging showed his pelvic hematoma was compressing his iliac veins and inferior vena cava (IVC). The patient was then encouraged to avoid supine positioning, and instead employ side to side turns in bed. Within 12 days, the patient’s lower extremity edema completely resolved, and his bodyweight dropped 33.3 kg.

Setting: Inpatient rehabilitationAssessment/

Results: At his highest bodyweight, the patient weighed 98 kg. Within 12 days of the recommendation to avoid supine positioning, his bodyweight dropped to 64.7 kg. His edema and associated pain completely resolved, and his ability to perform ADLs such as transfers, and lower body dressing improved.

Discussion: Lower extremity edema can limit the ability to perform activities of daily living (ADL) due to pain, reduced range of motion, and increased weight of the limbs. In this case, the fluid in the patient’s legs was not able to return to the heart due to compression of the IVC/iliac veins, and was not amenable to diuresis or compression garments. Changing positioning in bed from predominantly supine to side to side likely alleviated the compression of his IVC, allowing fluid to return to his heart, and be diuresed.

Conclusion: Sidelying positioning to reduce external compression of pelvic vasculature can improve fluid return to the heart. Consider this etiology and management for lower extremity edema in patients with recent abdominal surgery whose edema is not responsive to conventional management.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/unique-positional-management-of-lower-extremity-edema-impacting-rehab-participation-in-the-setting-of-pelvic-hematoma-a-case-report/