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• W2921242843 abstract "Patients with inflammatory bowel disease (IBD) are at increased risk for thrombosis, particularly during acute flares. We report a case of phlegmasia cerulean dolens (PCD) in a patient with uncontrolled ulcerative colitis (UC), which led to limb ischemia and amputation.A 26-year-old male with poorly controlled UC presented with left leg pain, swelling, and discoloration. He reported a traumatic left ankle injury two days prior, at which time X-rays were negative for fracture. Physical exam was consistent with compartment syndrome and labs were notable for Hgb 8.2 gm/dL and albumin 2.4 gm/dL. Doppler ultrasound revealed acute deep venous thrombosis of the left femoral and popliteal veins. He was started on heparin and underwent fasciotomy. Days later, he was noted to have left arm pain, swelling, and discoloration; doppler ultrasound showed occlusive thrombi in the left brachial and axillary veins. Due to non-viability of the left leg, the patient was not a candidate for thrombolysis or thrombectomy and ultimately required below the knee amputation. His left hand was preserved though with dry gangrenous changes to the fingertips. Workup for hypercoagulable states was negative. His UC had failed to respond to both mesalamine and adalimumab prior to beginning vedolizumab six months prior to presentation. Flexible sigmoidoscopy revealed severe inflammation starting from the rectum that extended at least 50 cm proximally consistent with Mayo endoscopic score of 3 (figure 1 A&B). Histopathologic exam confirmed active colitis (figure 2). Total colectomy with end ileostomy was performed for definitive management of UC. Patient was discharged with apixaban anticoagulation. PCD is a rare clinical phenomenon in which acute extensive venous thrombosis leads to massive edema and compromise of arterial blood flow. PCD can rarely occur in the setting of IBD, especially during active disease periods. Malignancy is the most common trigger, followed by other hypercoagulable states such as inherited thrombophilias, recent surgery, and trauma; up to 10% of cases are idiopathic. Our case highlights the catastrophic complication that may occur with PCD, amputation, which has not been previously reported in IBD patients. Limb salvage has been reported when catheter-based thrombolysis or surgical thrombectomy are performed early. Appropriate management of IBD is necessary to prevent such hypercoagulable states that lead to morbid complications.2092_A Figure 1. Significant edema, hyperemia, friability, loss of colonic folds and vascular pattern, and severe ulceration in sigmoid colon consistent with Mayo endoscopic score of 3.2092_B Figure 2. Significant edema, hyperemia, friability, loss of colonic folds and vascular pattern, and severe ulceration in rectum consistent with Mayo endoscopic score of 3.2092_C Figure 3. Sigmoid colon biopsy with chronic active colitis (40X magnification)." @default.
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• W2921242843 date "2018-10-01" @default.
• W2921242843 modified "2023-09-26" @default.
• W2921242843 title "Catastrophic Phlegmasia Cerulea Dolens in Inflammatory Bowel Disease" @default.
• W2921242843 doi "https://doi.org/10.14309/00000434-201810001-02091" @default.
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