Necrotising fasciitis of the left leg caused by perforated caecal adenocarcinoma

Abstract

An 82-year-old man presented with abdominal pain and a painful and swollen left thigh. On examination there was oedema, tenderness and crepitus with skin discoloration of the left thigh. Computed tomography showed retroperitoneal perforation of the caecum and necrotising fasciitis of the left thigh. A right hemicolectomy and repeated fasciotomies of the left thigh with debridement of necrotic tissue were performed but the patient died of multi-organ failure. Histology showed a pT4aN2c caecal adenocarcinoma. This is a unique presentation of a retroperitoneal caecal perforation and acts as a reminder that unexplained severe fasciitis of the thigh may be caused by an intra-abdominal pathology.

Necrotising fasciitis of the thigh caused by duodenum invasion of renal cell carcinoma: A case report

“…In this case, although there was deterioration in inflammatory parameters, diagnosis could only be made after 3 days of admission to the palliative care unit. As in most of the cases reported in the literature (6,(8)(9)(10)12), endogenous origin could be established after the debridement operation, usually via computerized tomography (CT). Although biliary contamination the day after the surgery obviously pointed to an intestinal fistula, a CT with oral contrast medium was ordered to aid the management of the case.…”

“…5 In such cases with a predisposing pathology, control of the source is also important. Emergent laparotomy was the preferred approach in most cases [6][7][8]10,12,13 except the one in which delayed colectomy after percutaneous drainage was performed. 9 We performed emergent laparotomy to repair the duodenal fistula.…”

“…12 The only fasciitis case caused by duodenum perforation was related to iatrogenic perforation of duodenum by a percutaneous transhepatic drainage catheter in a patient with pancreatic head cancer, but fasciitis was found in the scrotum (ie, Fournier's gangrene). As in most of the cases reported in the literature (6,(8)(9)(10)12), endogenous origin could be established after the debridement operation, usually via computerized tomography (CT). Diagnosis of necrotising fasciitis is usually delayed because of insidious changes on the skin and can be mistaken as cellulitis.…”

“…In this case, although there was deterioration in inflammatory parameters, diagnosis could only be made after 3 days of admission to the palliative care unit. Emergent laparotomy was the preferred approach in most cases [6][7][8]10,12,13 except the one in which delayed colectomy after percutaneous drainage was performed. Although biliary contamination the day after the surgery obviously pointed to an intestinal fistula, a CT with oral contrast medium was ordered to aid the management of the case.…”