Atraumatic Idiopathic Compartment Syndrome Requiring Emergent Fasciotomy: A Case Report and Literature Review

TL;DR

A 42-year-old man with no medical history developed severe leg pain and swelling from a blood clot, requiring emergency surgery to relieve pressure.

Contribution

This case report highlights a rare instance of atraumatic compartment syndrome without coagulopathy or anticoagulation.

Findings

Atraumatic hematoma in the gastrocnemius-soleus complex caused acute compartment syndrome.

No coagulopathy or bleeding source was identified despite extensive workup.

Emergent fasciotomy was necessary to treat the condition.

Abstract

A 42-year-old male with no past medical history presented to an emergency room with increasing pain and swelling of his left lower extremity over 48 hours with no preceding trauma. A computed tomography scan demonstrated a hematoma (20 cm × 4 cm × 10 cm) present within the gastrocnemius-soleus complex. Acute compartment syndrome (ACS) was diagnosed clinically, confirmed intraoperatively with an arterial line transducer, and treated with emergent fasciotomy. Extensive workup found no evidence of coagulopathy or source of bleeding. This case presents a patient with ACS secondary to an atraumatic gastrocnemius hematoma discovered in the emergency room with no history of coagulopathies or anticoagulation.

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