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Compartment Syndrome Secondary to Phlegmasia Cerulea Dolens in a Patient With Crohn's Disease
Saad Mohammed Alshahrani1,2, Raghad Ibrahim Alkoblan2,3, Reem Abdulaziz Alturki2,3
1Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Insights
Phlegmasia cerulea dolens, a severe deep vein thrombosis complication, is more common in inflammatory bowel disease patients. Early recognition and treatment are crucial for managing this rare but life-threatening condition.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Thrombosis Research
Background:
- Phlegmasia cerulea dolens (PCD) is a rare, severe deep vein thrombosis (DVT) complication causing limb swelling, pain, and cyanosis.
- Inflammatory bowel disease (IBD), including Crohn's disease, significantly increases venous thromboembolism (VTE) risk due to chronic inflammation and hypercoagulability.
- Untreated PCD can lead to venous gangrene, compartment syndrome, and circulatory shock, necessitating urgent intervention.
Purpose of the Study:
- To report a case of phlegmasia cerulea dolens in a young male with Crohn's disease.
- To emphasize the critical need for prompt diagnosis and management of PCD in IBD patients.
- To highlight the association between Crohn's disease and increased thrombotic risk.
Main Methods:
- A case report detailing a 26-year-old male with a history of Crohn's disease, nonadherence, and VTE.
- Diagnostic tools included Doppler ultrasonography and clinical evaluation for compartment syndrome.
- Interventions involved emergency fasciotomy, popliteal artery embolectomy, blood transfusion, and exploratory laparotomy with hemicolectomy and ileostomy.
Main Results:
- The patient presented with acute iliofemoral DVT extending to the inferior vena cava and confirmed compartment syndrome.
- Emergency surgical interventions successfully restored circulation and prevented ischemic injury.
- Postoperative management included addressing lower gastrointestinal bleeding and recovery following extensive abdominal surgery.
Conclusions:
- This case underscores the importance of recognizing PCD in IBD patients, especially younger individuals with risk factors.
- Prompt management, including surgical intervention and addressing underlying conditions, is vital for favorable outcomes.
- The case reinforces the heightened thrombotic risk associated with Crohn's disease and treatment nonadherence.
Abstract:
BACKGROUND Phlegmasia cerulea dolens is a rare, potentially fatal complication of deep vein thrombosis characterized by sudden limb swelling, pain, and cyanosis. The prevalence of venous thromboembolism is estimated to be 1.5 to 3.5 times higher in patients with inflammatory bowel disease than in the general population. Without prompt treatment, it may progress to venous gangrene, compartment syndrome, or circulatory shock. Crohn's disease, a chronic inflammatory bowel disorder, increases the risk of thromboembolic events due to persistent inflammation and hypercoagulability, which can precipitate phlegmasia cerulea dolens. CASE REPORT A 26-year-old male smoker with a history of fistulizing Crohn's disease, nonadherence to his prescribed regimen, chronic pulmonary embolism, and prior inferior vena cava filter placement presented with acute right lower limb swelling and pain. Doppler ultrasonography revealed extensive iliofemoral deep vein thrombosis extending into the inferior vena cava; clinical evaluation confirmed compartment syndrome. Emergency fasciotomy and popliteal artery embolectomy restored circulation and prevented ischemic injury. Subsequently, the patient required a blood transfusion due to lower gastrointestinal bleeding, followed by an emergent exploratory laparotomy with right hemicolectomy, ileocecal resection, and ileostomy after colonoscopy failed to identify an active bleeding source. The patient recovered well postoperatively. CONCLUSIONS This case highlights the importance of early recognition and prompt management of phlegmasia cerulea dolens in patients with inflammatory bowel disease, particularly among younger individuals with an increased risk of thrombotic complications.
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