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

Abstract

Necrotising fasciitis, widespread necrosis of the skin, subcutaneous tissue, and superficial fascia, may be caused by many factors, among which underlying malignancy is observed rarely. We report a case with necrotising fasciitis of the lower extremity because of a duodenum to retroperitoneum fistula caused by renal cell carcinoma invasion. A 62‐year‐old male with newly diagnosed renal cell carcinoma was diagnosed with necrotising fasciitis at the end of 2 days in hospital. One day after debridement surgery, biliary contamination of dressings and tomography demonstrated fistulation from the duodenum to retroperitoneum and then to the right thigh because of renal tumour invasion. The second operation was performed to repair the duodenum. Intravenous antibiotics and hydration were maintained postoperatively. Although there was no surgical complication, the patient died because of respiratory collapse at the 12th day postoperatively. Renal cell carcinoma may invade the duodenum and, with retroperitoneal fistulation, may be the cause of necrotising fasciitis of the thigh. Laparotomy may be needed to control the origin of infection. However, necrotising fasciitis may be fatal in spite of aggressive treatment. The fasciitis should be diagnosed early to initiate timely aggressive treatment, and a possible endogenous source should be kept in mind.

Rare presentation of necrotizing fasciitis in complicated diverticulitis

“…Diagnosis is often delayed due to insidious changes on the skin. Despite adequate treatment, mortality may be as high as 22–48% 6 …”

“…[1][2][3] However, complications that occur from retained gallstones include simple abscesses, fistula and rarely small bowel obstruction. [4][5][6] As such, it is important that all gallstones be retrieved when possible. We report a rare case of a retained gallstone impacting mesorectum, causing non-specific symptoms of diarrhoea and intermittent fevers.…”