Extensive necrotizing fasciitis of the thoracic wall and retroperitoneum following penetrating trauma: A case report of severe septic shock and multistage surgical management.

INTRODUCTION: Necrotizing fasciitis (NF) of the thoracic wall with retroperitoneal extension is an exceptionally rare and life-threatening condition. It is associated with high morbidity and mortality due to its rapid progression, diagnostic difficulty, and complex surgical requirements.

CASE PRESENTATION: A previously healthy male developed fulminant NF following minor penetrating thoracic trauma. He presented with septic shock, leukocytosis (WBC 54,000/μL), and lactic acidosis. Imaging revealed gas-forming infection extending from the thoracic fascia into the retroperitoneum. The LRINEC score was 10. Cultures identified Acinetobacter baumannii.Emergency radical debridement was performed, including excision of multiple thoracic muscles and retroperitoneal fascial planes. Over 14 days, five staged surgeries were required. Postoperative management included intensive care, broad-spectrum antibiotics, negative-pressure wound therapy, and delayed reconstruction with a pedicled flap and skin grafts.The patient survived despite a predicted mortality over 80%. At six-month follow-up, he had full functional recovery without recurrence.

CONCLUSION: This case underscores the diagnostic and therapeutic challenges of truncal NF. Early recognition, aggressive surgical intervention, and coordinated critical care are vital to survival in such catastrophic infections.