Compartment Syndrome Secondary to Phlegmasia Cerulea Dolens in a Patient With Crohn's Disease.

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.