Maintaining the lithotomy position and operation time for more than 2~4 hours, may cause swelling and pain of the
lower extremity due to acute compartment syndrome and deep vein embolism. A 65-year-old man suddenly felt lower
extremity swelling and pain after undergoing six hours of colon cancer surgery in the lithotomy position. After a series of
the workup, exclude acute compartment syndrome and deep vein thrombosis. The history of gout was confirmed, clinical
symptoms are sudden left lower limb swelling and pain, redness and gradually confined to the left knee joint, hyperuricemia
and the X-ray reveals left supra-patellar pouch with a product of synovial fluid. The clinical symptoms consistent with 2015
ACR and the European Union Rheumatology (European League Against Rheumatism, EULAR) diagnostic criteria for gout,
gout was diagnosed. Following the clinical guidelines for gout, the symptoms are relieved within a week. In the literature, it
was found that dehydration and insufficient water intake can trigger gout attacks. This case is in the process of preparing for
colon cancer surgery, fasting before surgery, diarrhea caused by bowel preparation, water intake is not enough and intravenous
fluid replacement is inadequate, these factors make acute gout is triggered. Based on this experience, recommended gout cases before undergoing bowel surgery,simultaneous monitoring of input and output when performing bowel cleansing, according
to the monitoring results, provide appropriate intravenous fluids to ensure adequate body fluids, uric acid is excreted by the kidneys, reduce the acute episode of gout is triggered.
