DOI: http://dx.doi.org/10.18203/2349-2902.isj20205383

Bowel perforation presenting as necrotizing soft-tissue infection of thigh a rare presentation

Navdeep Garg, Kunal Singla, Maninder Singh, Mandeep Singh, Rajesh Kumar Bansiwal, Rajeev Sharma

Abstract


Necrotizing soft-tissue infections (NSTI) are characterized by extensive and rapidly progressing soft tissue inflammation with necrosis. It typically involves a gas-forming bacterium such as group A b-hemolytic Streptococcus or a Clostridium species. This gas formation leads to the radiographic finding of subcutaneous emphysema. It is recognized as a surgical emergency. NSTI of the abdominal wall, flank, or thigh resulting from break-in bowel integrity is an atypical presentation that may cause delayed recognition and treatment, resulting in a mortality rate greater than that in Fournier gangrene. Early detection and aggressive surgical debridement are crucial to reduce patient mortality and morbidity. We present the case of a 30-year-old patient presenting with fasciitis of lower limb. Surgical exploration revealed the source of the emphysema to be an entero-cutaneous fistula. The patient had an unstable and prolonged hospitalization after debridement of the thigh and abdominal surgery and was discharged after one month. It suggested that clinical presentation can be highly variable and range from early sepsis with obvious skin involvement to minimal cutaneous manifestations of underlying disease.


Keywords


Necrotizing fasciitis, Bowel perforation, Soft tissue infection, Rare presentation, Peritonitis

Full Text:

PDF

References


Bosshardt TL, Henderson VJ, Claude H Organ J. Necrotizing soft-tissue infections. Surgical Treatment: Evidence-Based and Problem-Oriented. Holzheimer RG, Mannick JA, editors. Munich: Zuckschwerdt. 2001.

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279-88.

Saldua NS, Fellars TA, Covey DC. Case Report: Bowel Perforation Presenting as Subcutaneous Emphysema of the Thigh. Clin Orthop Relat Res. 2010;468(2):619-23.

McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of Mortality for Necrotizing Soft-Tissue Infections: Ann Surg. 1995;221(5):558-65.

Nijhof HW, Steenvoorde P, Bonsing BA, Hartgrink HH. Necrotizing soft tissue infection of the thigh: consider an abdominal cause. World J Surg. 2006;30(10):1836-42.

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