Gluteal compartment syndrome following prolonged immobilization in the setting of polysubstance use: A two-patient case series

Introduction Gluteal compartment syndrome (GCS) is a rare, often overlooked emergency caused by rising compartment pressures leading to muscle and nerve ischemia, frequently after substance-related immobilization. Nonspecific symptoms such as diffuse pain and reduced mobility contribute to delayed diagnosis, increasing risk of irreversible neuromuscular injury and death. Case summary Two cases of GCS following polysubstance overdose are presented. • Case 1 : A 44-year-old male developed right-sided GCS with extensive gluteal muscle necrosis following delayed diagnosis, initially misattributed to cellulitis. Despite decompressive fasciotomy, he suffered irreversible muscle loss . • Case 2 : A 35-year-old male presented with multisite compartment syndrome of the left gluteal, forearm, and lower leg compartments. Prompt recognition and surgical decompression preserved overall tissue viability. Discussion Diagnosis of GCS relies on a combination of laboratory findings such as markedly elevated creatinine kinase, and focused physical examination particularly tense gluteal swelling, pain disproportionate to the clinical scenario, and progressive neurological deficits, including sciatic nerve dysfunction or foot drop. Imaging is often nonspecific, and clinical outcomes are dependent highly on early fasciotomy. These cases highlight the variable clinical course of GCS and the diagnostic challenges in patients found immobile after overdose. Conclusion Clinicians should remain vigilant of the possibility of GCS in patients immobilized after drug overdose. Early recognition is critical to reducing morbidity and mortality within these patients. Prompt surgical consultation and early fasciotomy are essential to prevent irreversible neuromuscular damage and poor functional recovery.