A Case of Necrotizing Soft Tissue Infection Secondary to Perforated Colon Cancer

Abstract

Necrotizing soft tissue infections are aggressive infections that cause necrosis of muscle, fascia, and tissue. They typically follow fascial planes that lack insufficient blood supply. Early drainage and debridement are essential for survival in these patients. This is a case of a patient who presented in diabetic ketoacidosis with a necrotizing soft tissue infection localized to the left flank and abdomen with underlying colon cancer pathology. The patient was a 54-year-old female who initially presented with acute dyspnea and left flank pain for two weeks. On admission, she was afebrile, tachycardic, tachypneic, and hypertensive. After being transferred to the ICU for diabetic ketoacidosis management, she began complaining of left abdominal pain and the CT showed concerns for a possible necrotizing soft tissue infection in the left flank region. She was taken to the operating room immediately for debridement and started on broad-spectrum antibiotics. The next day, an exploratory laparotomy was performed with a hemicolectomy and creation of an end colostomy due to concern for a perforated colonic malignancy. A final debridement was completed and a wound vacuum-assisted closure (VAC) was placed. Final pathology demonstrated well-differentiated colonic adenocarcinoma invading into the muscularis propria. Overall, necrotizing soft tissue infections can be related to a perforated viscus especially a colonic malignancy and this case demonstrates the importance of proper surgical management and high clinical suspicion for possible underlying pathology in a soft tissue infection.

Keywords: cellulitis; colon cancer; malignancy; myositis; necrosis; necrotizing fasciitis; necrotizing soft tissue infection; nf; nsti; soft tissue infection.

Figure 1. Left flank and left lower quadrant on admission

Figure 2. CT abdomen and pelvis showing subcutaneous air in the retroperitoneum extending into the left flank

Figure 3. Post-operative day #1 after initial debridement

Figure 4. CT abdomen and pelvis showing thickening of sigmoid colon

Figure 5. Sigmoid colon cancer specimen

Figure 6. Wound healing at 2.5 months