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

Sep 28, 2026

Case report details an unusual clinical course of a 26-year-old man with fistulizing Crohn’s disease who was a smoker and nonadherent to therapy. He presented with acute right lower-limb swelling and pain, and Doppler ultrasound showed extensive iliofemoral deep vein thrombosis extending to the inferior vena cava, with exam confirming compartment syndrome. Emergency fasciotomy and popliteal artery embolectomy restored circulation. Subsequent management included treatment for lower gastrointestinal bleeding and emergent right hemicolectomy, ileocecal resection, and ileostomy after colonoscopy failed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Background

Case Report

Conclusions

Introduction

Phlegmasia cerulea dolens overview

Relationship with Crohn’s disease and thrombosis risk

e-ISSN 1941-5923 © Am J Case Rep, 2025; 26: e948950 DOI: 10. 12659/AJCR.948950 Received: 2025.03.14 Accepted: 2025.10.16 Available online: 2025.11.12 Published: 2025.12.15 Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G ABEF ABE ABEF AE 1,2 2,3 2,3 1,2 Corresponding Author: Financial support: Conflict of interest: Compartment Syndrome Secondary to Phlegmasia Cerulea Dolens in a Patient With Crohn’s Disease Saad Mohammed Alshahrani Raghad Ibrahim Alkoblan Reem Abdulaziz Alturki Shahad Mohammed Alashgar 1 Emergency Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 2 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia 3 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Saad Mohammed Alshahrani, e-mail: [saad-sh16@hotmail.com](saad-sh16@hotmail.com) None declared None declared Patient: Male, 26-year-old Final Diagnosis: Compartment syndrome • phlegmasia cerulea dolens Symptoms: Lower limb muscle weakness • lower limb pain and edema Clinical Procedure: — Specialty: Critical Care Medicine • Gastroenterology and Hepatology • Surgery Objective: Unusual clinical course 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. Keywords: Compartment Syndromes • Crohn Disease • Fasciotomy • Thrombosis Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/948950](https://www.amjcaserep.com/abstract/index/idArt/948950) 2286 — 3 28 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) e948950-1 Indexed in: [PMC] [PubMed] [Emerging Sources Citation Index (ESCI)][Web of Science by Clarivate] Alshahrani [S.M. et](S.M. et) al: Compartment syndrome in PCD with Crohn’s disease © Am J

FAQs

What is phlegmasia cerulea dolens and why is it dangerous in this case?

Phlegmasia cerulea dolens (PCD) is a rare, potentially fatal deep vein thrombosis complication with sudden limb swelling, pain, and cyanosis. If not treated promptly, it can progress to venous gangrene, compartment syndrome, or circulatory shock.

How was the diagnosis of compartment syndrome established?

The patient’s acute right lower limb swelling and pain prompted evaluation, and Doppler ultrasonography demonstrated extensive iliofemoral deep vein thrombosis extending into the inferior vena cava. Clinical assessment confirmed compartment syndrome.

What treatments were performed and what were the outcomes?

Emergency fasciotomy and popliteal artery embolectomy restored circulation and prevented ischemic injury. The patient later required blood transfusion for lower gastrointestinal bleeding, followed by emergent exploratory laparotomy with right hemicolectomy, ileocecal resection, and ileostomy; he recovered well postoperatively.

Sep 28, 2026

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