Atraumatic lower leg compartment syndrome in untreated chronic myeloid leukemia: a case report

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Abstract Background Chronic myeloid leukemia (CML) rarely presents with spontaneous soft tissue bleeding severe enough to cause compartment syndrome. In such cases, surgical decompression performed before recognition of the underlying hematologic disorder may be followed by severe postoperative hemorrhage. Case presentation A 45-year-old man with previously diagnosed but untreated CML developed rapidly progressive atraumatic pain and swelling of the right lower leg. He presented to a secondary hospital, where markedly elevated intracompartmental pressures led to the diagnosis of acute compartment syndrome. Emergent fasciotomy was performed. Although compartment pressures improved after decompression, postoperative bleeding became uncontrollable, requiring repeated transfusions and reoperation. Only after surgery did the patient disclose his untreated CML, and he was transferred to our institution. Urgent hematologic intervention was initiated; however, bleeding remained difficult to control. A damage-control strategy consisting of shoelace approximation, sustained compression, transfusional support, and staged wound management resulted in gradual hemodynamic stabilization and definitive wound closure approximately one month later. At long-term follow-up, limb salvage was achieved without infection or recurrent bleeding. The patient regained full ankle motion, had no motor deficit, and returned to recreational running. Functional outcomes were favorable, with a KOOS of 88 and an AOFAS ankle-hindfoot score of 96. Computed tomography demonstrated a persistent bilobed organized hematoma. Conclusion Leukemia-associated compartment syndrome should be considered a high-risk surgical emergency. When true acute compartment syndrome is present, urgent fasciotomy remains essential. However, severe postoperative bleeding may occur when significant hematologic abnormalities remain unrecognized. Early hematologic evaluation together with multidisciplinary management may facilitate successful limb salvage and favorable long-term functional recovery in atypical non-traumatic presentations.

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