Rectal perforation secondary to invasive cervical cancer presenting as perineal necrotizing fasciitis with subsequent hindquarter amputation: a case report


  • Matthew L. Basa Department of General Surgery, Royal Brisbane and Women’s Hospital, Queensland Health, Brisbane, Queensland, Australia, School of Clinical Medicine, Royal Brisbane Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
  • Andrew Riddell Department of General Surgery, Redcliffe Hospital, Queensland Health, Redcliffe, Queensland, Australia



Necrotizing fasciitis, Rectal perforation, Cervical cancer


Necrotizing fasciitis (NF) is a life-threatening soft tissue infection rarely associated with gynecological malignancies. We present a unique case of NF arising from a locally advanced cervical cancer eroding into the rectum, causing occult fecal spillage leading to severe infection and necessitating a hindquarter amputation. A 39-year-old woman presented with sepsis and a necrotic gluteal wound. Extensive debridement revealed "dishwater"-like discharge throughout the left leg fascial compartments, necessitating hindquarter amputation. Despite initial suspicion of a primary skin infection, further investigation revealed a posterolateral rectal perforation secondary to advanced cervical cancer, confirmed by biopsy and imaging. Microbiology identified Streptococcus constellatus, intermedius, and anginosus. This case highlights the atypical presentation of NF associated with advanced cervical cancer. High clinical suspicion and early surgical intervention are crucial for survival. This case expands the understanding of NF etiology and emphasizes the importance of considering rare causes, even in the absence of traditional risk factors.


Nawijn F, de Gier B, Brandwagt DAH, Groenwold RHH, Keizer J, Hietbrink F. Incidence and mortality of necrotizing fasciitis in The Netherlands: the impact of group A Streptococcus. BMC Infect Dis. 2021;21(1):1217.

Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, et al. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg. 2016;11:40.

Gallup DG, Freedman MA, Meguiar RV, Freedman SN, Nolan TE. Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency. Am J Obstet Gynecol. 2002;187(2):305-10.

Schorge JO, Granter SR, Lerner LH, Feldman S. Postpartum and vulvar necrotizing fasciitis. Early clinical diagnosis and histopathologic correlation. J Reprod Med. 1998;43(7):586-90.

Vettorazzi J, Valério EG, Faulhaber GAM, Perez AV, et al. Necrotizing Fasciitis in the Puerperium of a Woman with Complement Deficiency: Case Report and Review Literature. Open Journal of Obstetrics and Gynecology. 2018;08(12):1236-46.

Nolan TE, King LA, Smith RP, Sbaraini M, Vettori DV. Necrotizing surgical infection and necrotizing fasciitis in obstetric and gynecologic patients. South Med J. 1993;86(12):1363-7.

Kumar D, Cortés-Penfield NW, El-Haddad H, Musher DM. Bowel Perforation Resulting in Necrotizing Soft-Tissue Infection of the Abdomen, Flank, and Lower Extremities. Surg Infect (Larchmt). 2018;19(5):467-72.

Chakravarthy A, Reddin I, Henderson S, Dong C, Kirkwood N, Jeyakumar M, et al. Integrated analysis of cervical squamous cell carcinoma cohorts from three continents reveals conserved subtypes of prognostic significance. Nature Communications. 2022;13(1):5818.

Sharma M, Agrawal A. Case report: Stercoral sigmoid colonic perforation with fecal peritonitis. Indian J Radiol Imaging. 2010;20(2):126-8.

Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705-10.

Foo RM, Tung ML, Poon LM, Chan D, Smitasin N, Koh LP, et al. Necrotizing Fasciitis in Hematological Patients: Enterobacteriaceae Predominance and Limited Utility of Laboratory Risk Indicator for Necrotizing Fasciitis Score. Open Forum Infect Dis. 2015;2(2):ofv081.

Gupta Y, Chhetry M, Pathak KR, Jha RK, Ghimire N, Mishra BN, et al. Risk Factors For Necrotizing Fasciitis And Its Outcome At A Tertiary Care Centre. J Ayub Med Coll Abbottabad. 2016;28(4):680-2.

Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A. Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy. 2015;8:1-7.

Fais P, Viero A, Viel G, Giordano R, Raniero D, Kusstatscher S, et al. Necrotizing fasciitis: case series and review of the literature on clinical and medico-legal diagnostic challenges. Int J Legal Med. 2018;132(5):1357-66.

Yaşar NF, Uylaş MU, Badak B, Bilge U, Öner S, İhtiyar E, et al. Can we predict mortality in patients with necrotizing fasciitis using conventional scoring systems? Ulus Travma Acil Cerrahi Derg. 2017;23(5):383-8.

Ballesteros-Betancourt JR, García-Tarriño R, Ríos-Guillermo J, Rodriguez-Roiz JM, Camacho P, Zumbado-Dijeres A, et al. Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale. Rev Esp Cir Ortop Traumatol. 2017;61(4):265-72.

Nawijn F, Smeeing DPJ, Houwert RM, Leenen LPH, Hietbrink F. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2020;15(1):4.

Itsiopoulos I, Vasiliadis AV, Tsitouras D, Goulas P, Malliou P, Ktenidis K. Amputation in Necrotizing Fasciitis - Dilemma or Reality: A Case Report and Literature Review. J Orthop Case Rep. 2020;10(4):54-8.






Case Reports