Necrotizing Fasciitis on the Abdomen, Perineal Area and Thigh after Panperitonitis

Abstract

Necrotizing fasciitis (NF) is a rare and rapidly progressive disease involving the skin, subcutaneous tissue, and deep soft tissue. A 76-year-old man presented to the emergency room with melena. Abdominopelvic angiographic computed tomography (CT) revealed a foreign body with calcific density in the ascending colon. Explorative operation was performed, and the foreign body observed on CT was identified to be a chicken bone. Mucosal tearing was found in the ascending colon, and right hemicolectomy was performed. Two days postoperatively, leakage from the anastomosis site was noted and eventually progressed to panperitonitis. One week later, the patient's skin and soft tissue changed to a purplish color, and swelling was observed. As the area gradually increased, a foul odor and purulent discharge were noted. We diagnosed this patient as having NF, and debridement and antibiotic treatment were started. Extended-spectrum 횓짼-lactamases positive Escherichia coli were identified in the excised tissue. After infection subsided, we reconstructed the defect with mesh split-thickness skin graft. The patient recovered without any postoperative complications. NF is an invasive infection that requires prompt diagnosis and treatment. Here, we report successful reconstruction of secondary NF caused by E. coli.