Case Summaries

Diver Suffers Hip Pain During Flight 36 Hours Postdive

A diver who had been on a multiple-day dive trip on a liveaboard experienced pain in his hips during the flight home. He was treated at a chamber on the third day after returning home. His symptoms resolved, but a diagnosis of DCS is uncertain.

Case Report

I am a 40-year-old novice diver, 5'6" (167 cm) tall and weighing 139 pounds (63 kg). My medical history includes ulcerative colitis (1994), colectomy and J pouch formation (2001). On a liveaboard trip in Caribbean, I did approximately two dives per day for nine days. I used compressed air and dived to depths from 35 fsw (11 msw) to 108 fsw (33 msw). Thirty-six hours after my last dive I flew from Miami to Las Vegas and from Las Vegas to San Francisco, for a total time of 12 hours with layover.

Approximately one-third of the way into the flight from Miami to Las Vegas, I experienced excruciating joint pain in my right and left hip, radiating down both legs. At that point I did not associate these symptoms with decompression illness (DCI). The pain was worse the next day, affecting my mobility. I took ibuprofen, codeine and Tylenol, but nothing helped. Two days after the flight, the pain was a little better.

On the third day I was working with a friend who is also a diver and a marine biologist. I mentioned my symptoms to her in passing, and she suggested I could have the "bends." I couldn't believe that I had not thought about this before! I called DAN and went to the emergency room; they transferred me to a hyperbaric chamber at a nearby hospital. That night I underwent a U.S. Navy Treatment Table 6 recompression and experienced complete resolution of the symptoms. The following day the pain returned in my lower back and sacroiliac-joint area, but it was not as severe as the original pain. I called the doctor who treated me, but he did not think I needed additional recompression treatments. All my symptoms have resolved at present.

Comments

Symptoms that occur 36 hours after the dive may be dive-related, but the probability is rather small. The described symptoms are not typical for DCS either. However, with the history of ulcerative colitis and J-pouch surgery, the local conditions in the pelvis may have contributed to the occurrence of the described symptoms. A resolution of symptoms with recompression treatment and hyperbaric oxygen is not necessarily confirmation of a diagnosis of DCI since hyperbaric oxygen may help with other inflammatory conditions.

In this particular case the diagnosis will remain unresolved. However, the physician who treated this diver did the right thing. When there are symptoms after a dive that could not be explained by another obvious cause, the patient should be treated with hyperbaric oxygen. The certainty of diagnosis is less important than the benefit for the patient, which was achieved in this case.

— Petar Denoble, M.D., D.Sc.