Phlegmasia cerulea dolens following internal hemipelvectomy: Case report and literature review
James A Butterworth1, Tam T Huynh2, Valerae O Lewis3
1Division of Plastic Surgery, University of Kansas, Kansas, Lawrence.
Insights
Phlegmasia cerulea dolens (PCD), a severe venous thrombosis, can be life-threatening. This case highlights emergent surgical intervention for PCD after internal hemipelvectomy, offering limb salvage and survival.
Area of Science:
- Vascular Surgery
- Oncology
- Emergency Medicine
Background:
- Phlegmasia cerulea dolens (PCD) is a severe venous thromboembolic complication.
- It arises from extensive venous thrombosis and occlusion, leading to limb ischemia.
- Malignancy is the most common predisposing factor for PCD.
Observation:
- A unique case of PCD developed post-internal hemipelvectomy.
- The patient presented with severe pain, cyanosis, and edema in the affected limb.
- This rare presentation necessitated immediate surgical management.
Findings:
- Emergent surgical intervention was crucial for limb salvage.
- Anticoagulation alone was insufficient in this critical scenario.
- The case underscores the importance of considering surgical options for PCD.
Implications:
- This case expands the understanding of PCD etiologies.
- It highlights the critical role of timely surgical intervention in life-threatening PCD.
- Findings support a multidisciplinary approach to managing complex venous thromboembolic events.
Abstract:
Phlegmasia cerulea dolens (PCD) results from near complete venous thrombosis and occlusion in an extremity resulting in pain, cyanosis, and edema and potentially death. While PCD can result from a variety of mechanisms including trauma, iatrogenic instrumentation, the majority of cases occur in the setting of malignancy. PCD is often managed medically with anticoagulation. However, in certain circumstances, surgical intervention may be warranted. Here, we present a unique case of phlegmasia cerulea dolens occurring following an internal hemipelvectomy requiring emergent surgical intervention to salvage life and limb. A review of the literature regarding diagnosis and treatment is also presented.
