title: Case report: Bowel perforation presenting as subcutaneous emphysema of the thigh.
abstract: Necrotizing fasciitis is recognized as a surgical emergency. Early detection and aggressive surgical débridement are crucial to reduce patient mortality and morbidity. There are, however, other causes of subcutaneous emphysema. We present the case of a 64 year-old patient with a history of postsurgical radiation for rectal carcinoma with subcutaneous emphysema of the thigh in the presence of urinary sepsis. Surgical exploration revealed the source of the emphysema to be an enterocutaneous fistula. The patient had an unstable and prolonged hospitalization after débridements of the thigh and abdominal surgery and was readmitted for recurrence of thigh drainage, but eventually was discharged; nine months after the initial diagnosis all wounds had healed and he was walking with a walker. Despite an otherwise benign clinical appearance, the radiographic finding of subcutaneous emphysema in the absence of penetrating trauma must be considered a case of a necrotizing soft tissue infection until proven otherwise.
authors: Department of Orthopaedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, Suite 112, San Diego, CA 92134, USA. Nelson.saldua@med.navy.mil
authors: Nelson S
authors: NS
authors: Saldua
authors: Todd A
authors: TA
authors: Fellars
authors: Dana C
authors: DC
authors: Covey
mesh_terms: D003646:Debridement; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D011859:Radiography; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D012086:Reoperation; D018805:Sepsis / Q000209:etiology; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D007507:Therapeutic Irrigation; D013848:Thigh; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000209:etiology