title: Necrotizing fasciitis secondary to carcinoma of the gallbladder with perforation.
abstract: We present an unusual case of necrotizing fasciitis in the upper abdominal wall caused by penetrating perforation of the gallbladder. It was manifested as an elastic and reddish abdominal swelling with severe tenderness, but no peritoneal irritation. Computed tomography (CT) demonstrated water density with a slightly elevated CT value and air bubbles in the subcutaneous space. The preoperative diagnosis was subcutaneous abscess with fasciitis. At surgery, necrotizing fasciitis and subcutaneous abscess secondary to penetrating perforation of the gallbladder were revealed. Cholecystectomy and peritoneal irrigation were performed. Although no tumor was evident during surgery, a tumor located close to the perforation site was found just after the operation. Pathological examination revealed gallbladder carcinoma without stones. There have been very few previous reports of necrotizing fasciitis following gallbladder perforation. The presentation, diagnosis, and management of fasciitis, as well as carcinoma of the gallbladder with perforation, are discussed.
authors.affiliation: Department of Surgery, Mito Red Cross Hospital, Sannomaru, Mito, Ibaraki 310-0011, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Okada
authors.forename: Tomoo
authors.initials: T
authors.lastname: Shatari
authors.forename: Tatsuma
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sasaki
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Suwa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Furuuchi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Takenaka
authors.forename: Masao
authors.initials: M
authors.lastname: Hori
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Sakuma
mesh_terms: D034861:Abdominal Wall; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D002763:Cholecystectomy / Q000379:methods; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed