Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer

Abstract

Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, KoreaNecrotizing fasciitis is one of the few true emergencies in orthopedic surgery that has a very high mortality rate unless recognized promptly and treated aggressively. The authors report a case of a patient with necrotizing fasciitis on the thigh that developed secondary to an unrecognized rectal cancer perforation through the short external rotator muscles. Clinicians should always be alert to the potential that rectal cancer perforations can cause necrotizing fasciitis in rare cases.

Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report

“…Unlike the case report by Kim et al 5) , the rare condition observed in the present case report, bilateral NF affecting the thigh and hip, has not yet been reported in the literature. Because older patients have a poorer prognosis relative to younger patients, the decision to perform any aggressive treatment in an elderly patient is made more difficult and complicated.…”

“…In a case report described by Kim et al (2013) 5) , rectal cancer was confirmed through additional examinations after managing NF around the unilateral thigh. However, unsatisfactory results were obtained due to the refusal of the patient and the patient's family members to undergo aggressive treatment.…”

“…It has a high rate of mortality ranging from 4.2% to 75%, and requires prompt, extensive surgical debridement and appropriate antibiotic therapy 2 , 3) . In previous studies, NF was most commonly found to develop unilaterally in a lower limb or hip 1 , 4 , 5) . Fournier gangrene, a form of NF of the perineal region, has been reported primarily in urology and general surgery, but not in orthopedic surgery.…”