Necrotizing Fasciitis in a Patient With Signet-Ring Cell Gastric Adenocarcinoma

Abstract

Necrotizing fasciitis is an aggressive infection of the skin and soft tissues that requires prompt recognition and management. Immediate source control and adjunctive antibiotic therapy are the cornerstones of management. There are limited reported cases of necrotizing fasciitis related to gastrointestinal malignancy, including gastric cancer. This report describes the case of a 36-year-old male who developed left abdominal wall necrotizing fasciitis related to perforated gastric adenocarcinoma with signet-ring features. Signet-ring adenocarcinoma is associated with a more aggressive malignancy. The rapid progression of the infection leading to refractory shock and acute respiratory distress rendered the patient a poor candidate for surgical source control because of high surgical risk. Patient eventually expired. Immediate recognition of necrotizing fasciitis and perforated gastric cancer can prompt early surgical referral for definitive source control and gastric resection or repair.

Keywords: complicated gastric cancer; necrotizing fasciitis; perforated gastric cancer; septic shock; signet ring cell adenocarcinoma.

Figure 1. CT scan showing a gastric mass with areas of necrosis and diffuse irregular gastric wall thickening

Black arrows show areas of necrosis within the gastric mass; Red arrow points to the gastric cavity.

Figure 2. Poorly distensible stomach with diffuse friable mucosal thickening on endoscopy

Black arrow shows friable gastric mucosa; Red arrow shows poorly distensible stomach.

Figure 3. Bullae with surrounding erythema and necrosis in the left hemiabdomen

Red arrow shows necrotic tissues.

Figure 4. CT scan showing extensive soft tissue emphysema in the anterior abdominal wall

Black arrow shows air within the gastric wall; Red arrow shows subcutaneous emphysema in the anterior abdominal wall.