Missed Wooden Perineum Foreign Body Leading to Extensive Necrotizing Soft Tissue Infection: A Case Report.

Penetrating perineal trauma is rare but carries a high risk due to contamination, hidden tracts, and proximity to major vessels and viscera. Retained organic foreign bodies, particularly wood, are often radiolucent and can perpetuate infection or erode into vascular structures. Necrotizing soft tissue infection (NSTI) is a devastating complication with significant mortality. A 53-year-old woman from rural Nepal presented 8 days after falling onto a tree branch, sustaining a perineal impalement. Her wound had been sutured primarily at a local center. She developed severe pain, swelling, foul discharge, and rectal bleeding. On exploration, extensive necrotic tissue and foul collections were found. MRI revealed a pelvic extension of infection but missed the wooden fragments. During subsequent staged debridements, two retained wooden pieces were discovered. Their removal precipitated massive pelvic hemorrhage requiring ligation of the right internal iliac artery. A loop colostomy was fashioned to prevent fecal contamination. After multiple surgeries and 53 days of inpatient care, she was discharged in stable condition.