Acute Gluteal Compartment Syndrome and Sciatic Nerve Palsy Following Prolonged Immobilization in an Intravenous Drug User: A Case Report

BACKGROUND Compartment syndrome is a serious condition characterized by increased interstitial pressure within a closed osseofascial compartment, which can result from decreased compartment volume, increased contents, or external pressures. Gluteal and thigh compartment syndrome, although rare, is linked to severe local complications such as tissue necrosis, infection, and even amputation, as well as systemic issues like renal failure and, in some cases, death. Prompt recognition and treatment are essential for improving outcomes, as delays significantly raise the risk of adverse and potentially life-threatening consequences. Acute gluteal compartment syndrome often results from prolonged pressure due to immobilization and can be associated with collapse caused by alcohol or drug abuse. CASE REPORT A 30-year-old male intravenous drug user (IVDU) was admitted with severe pain, swelling, and motor deficits in the right thigh and gluteal region due to prolonged immobilization during loss of consciousness from drug use. Examination revealed sciatic nerve palsy. Magnetic resonance imaging (MRI) showed swelling of the gluteal and posterior thigh muscles along with fluid collection. Emergency fasciotomy and sciatic nerve release were performed through a posterior approach. Postoperatively, the patient experienced rapid improvement in neurological function and mobility. CONCLUSIONS Our findings underscore the importance of maintaining a high index of suspicion among immobilized patients, especially intravenous drug users who may remain unconscious for extended periods, crushing parts of their bodies. Early recognition and intervention are vital for preventing severe complications associated with this condition. This case highlights the need for increased awareness and proactive management when treating IVDUs presenting with severe pain in the gluteal or thigh region and acute sciatic nerve palsy.