DOI: https://doi.org/10.36347/sasjs.2026.v12i05.024

Pages: 460-464

Background: Iliopsoas abscess is a rare but severe complication of Crohn's disease, typically arising from transmural inflammation and fistulization. Extension to the lower limb with associated necrotizing fasciitis is exceptional and life-threatening, with only a limited number of cases reported in the literature. Case Presentation: A 34-year-old male with untreated Crohn's disease presented with a right iliac fossa enterocutaneous fistula, subocclusive symptoms, fever, and progressive right lower limb impairment. CT scan showed an iliopsoas abscess associated with necrotizing fasciitis of the thigh. Emergency surgery found fistulized ileal loops communicating with a retroperitoneal abscess extending to the lower limb. Management included drainage, ileocolic resection, and stoma creation, along with extensive necrosectomy. Postoperatively, the patient was admitted to the intensive care unit, and placed on norepinephrine support. He was subsequently transferred to the plastic surgery unit for complementary necrosectomy and was discharged with a functional stoma. Discussion: Iliopsoas abscess in Crohn's disease is usually secondary to fistulizing ileocecal disease. Spread through the retroperitoneal space and along fascial planes may lead to thigh involvement and, in severe cases, necrotizing fasciitis. Early recognition based on imaging, prompt surgical drainage, broad-spectrum antibiotics, and aggressive debridement are essential to reduce morbidity and mortality. Conclusion: This case highlights a rare and severe presentation of Crohn's disease complicated by enterocutaneous fistula, iliopsoas abscess, and extensive necrotizing fasciitis of the lower limb. A multidisciplinary and aggressive surgical approach is crucial for patient survival.