Necrotizing fasciitis of the thigh-a devastating sign of intestinal perforation.

BACKGROUND

The incidence of necrotizing soft tissue infections is increasing, and associated mortality remains high. It is important to make an early diagnosis, but diverse atypical presentations occur.

PATIENT: An older adult patient was admitted with sepsis syndrome without localizing clues. Necrotizing fasciitis of the right thigh and gluteus developed, and CT revealed an adjacent inflammatory cecum mass which was diagnosed during surgery as perforated adenocarcinoma.

CONCLUSION

A review of the literature revealed that this rare type of necrotizing soft tissue infection is characteristic of rectosigmoid or ascending colon perforation, often being its presenting feature and the first clue to an occult underlying disease. Myriad etiologies of perforations have been reported to be associated with thigh, flank, or abdominal wall necrotizing fasciitis and peritonitis, but this syndrome remains poorly recognized. Better awareness will lead to more timely diagnosis and aggressive multifaceted treatment, which are essential for patient survival.