Bowel perforation presenting as necrotizing soft-tissue infection of thigh a rare presentation

Abstract

Necrotizing soft-tissue infections (NSTI) are characterized by extensive and rapidly progressing soft tissue inflammation with necrosis. It typically involves a gas-forming bacterium such as group A b-hemolytic Streptococcus or a Clostridium species. This gas formation leads to the radiographic finding of subcutaneous emphysema. It is recognized as a surgical emergency. NSTI of the abdominal wall, flank, or thigh resulting from break-in bowel integrity is an atypical presentation that may cause delayed recognition and treatment, resulting in a mortality rate greater than that in Fournier gangrene. Early detection and aggressive surgical debridement are crucial to reduce patient mortality and morbidity. We present the case of a 30-year-old patient presenting with fasciitis of lower limb. Surgical exploration revealed the source of the emphysema to be an entero-cutaneous fistula. The patient had an unstable and prolonged hospitalization after debridement of the thigh and abdominal surgery and was discharged after one month. It suggested that clinical presentation can be highly variable and range from early sepsis with obvious skin involvement to minimal cutaneous manifestations of underlying disease.