Perforated carcinoma of the caecum presenting as necrotising fasciitis of the abdominal wall, the key to early diagnosis and management

Marron, Conor; McArdle, G.; Rao, Milind; Sinclair, Stephen; Moorehead, John

doi:10.1186/1471-2482-6-11

Cited by 31 publications

(26 citation statements)

References 9 publications

(13 reference statements)

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“…phritis, perianal abscess, colon cancer, perforation, or postsurgical complications (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Extra-abdominal primary sources of infection with retroperitoneal spread have also been described, most commonly involving necrotizing fasciitis of the extremities.…”

Section: Teaching Pointsmentioning

confidence: 97%

Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis

et al. 2015

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Retroperitoneal fasciitis is a rare but potentially lethal complication of infection. Early diagnosis is crucial and is usually made when there is a high degree of clinical suspicion combined with characteristic imaging findings leading to early surgical intervention. Computed tomography (CT) can play a central role in demonstrating early findings, assessing the extent of disease to help determine the best surgical approach, identifying the primary source of infection, and evaluating the treatment response. The possible presence of retroperitoneal fasciitis should be considered in patients presenting with symptoms of sepsis, including pain that is disproportionate with the clinical abnormality. When retroperitoneal fasciitis is suspected, emergency CT can facilitate early diagnosis and evaluation of the extent of disease. Common findings at CT include fascial thickening and enhancement, muscular edema, fat stranding, fluid collections, and abscess formation. Gas tracking along fascial planes in the retroperitoneum is the hallmark of retroperitoneal fasciitis but is not seen in all cases. Another important clue to the diagnosis is asymmetric involvement of the retroperitoneal fascial planes and deep tissues. Fasciitis in the retroperitoneum may originate from infected retroperitoneal organs or from infection that spreads along indirect and/or direct pathways from a primary source elsewhere in the body. Findings of indirect tracking and transgression of fascial planes may indicate more severe infection associated with the necrotizing form of retroperitoneal fasciitis. Despite aggressive antibiotic treatment, early and repeated surgical débridement may be required to remove nonviable tissue in patients with the necrotizing form of retroperitoneal fasciitis. Awareness of the anatomy of the retroperitoneum, potential routes of spread of infection, and the spectrum of CT findings in retroperitoneal fasciitis is needed to achieve prompt diagnosis and guide treatment.

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Section: Teaching Pointsmentioning

confidence: 97%

Retroperitoneal Fasciitis: Spectrum of CT Findings in the Abdomen and Pelvis

et al. 2015

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“…Only sparse case reports describe the rare association between NSTI and colorectal malignant disease [11]. All such cases are attributed to bowel perforation, resulting in NSTI over the perineal or abdominal region [12]. Isolated upper or lower limb presentations are exceedingly uncommon.…”

Section: Definitionmentioning

confidence: 99%

“…Systemic findings include diaphoresis, tachycardia disproportionate to temperature elevation, and extreme anxiety. Late complications include intravascular hemolysis, hemoglobinuria, hypotension, renal failure, and metabolic acidosis [12]. The disease progresses rapidly over the course of hours and is frequently fatal if not interdicted immediately by aggressive surgical debridement [18].…”

Section: Diagnostic Toolsmentioning

confidence: 99%

Necrotizing soft tissue infections

Caínzos

González-Rodríguez

2007

Current Opinion in Critical Care

104

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Necrotizing soft-tissue infection is a rare infection of the subcutaneous tissue and fascia that is often associated with sepsis and can progress rapidly with a possible fatal outcome. Although the cause is not yet understood fully, patients often have a prior history of a small, trivial trauma, wound, or scratch. Establishing the diagnosis can be the main challenge in treating patients, and knowledge of all available tools is key for early and accurate diagnosis.

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“…Abdominal plain X-ray demonstrates soft tissue gas 6 in 57% of cases. 7 CT scan examination demonstrates the presence of sepsis (as retroperitoneal free gas or changes in mesorectal fat) in nearly all cases. 8 Antimicrobial therapy should be initiated immediately and directed against both aerobes and anaerobes, as study of the aerobic and anaerobic microbiology of 23 retroperitoneal pelvic sepsis patients revealed that in 50% of cases both aerobes and anaerobes were recovered.…”

Section: Discussionmentioning

confidence: 99%