Phlegmasia cerulea dolens and compartment syndrome secondary to uterine lipoleiomyoma

In this report, we describe the case of a woman with phlegmasia cerulea dolens of the lower left extremity secondary to iliac vein compression by a massive uterine lipoleiomyoma. She underwent left iliofemoral vein mechanical thrombectomy for prevention of critical limb ischemia days before a total abdominal hysterectomy. Immediately after thrombectomy, she developed compartment syndrome, requiring four-compartment fasciotomy. She developed recurrent thrombosis of the left iliac vein and inferior vena cava, requiring further thrombectomy at the time of hysterectomy before placement of an infrarenal inferior vena cava filter. She later underwent fasciotomy incision closure and was discharged on anticoagulation with resolution of her symptoms.