Extended retroperitoneal necrotizing fasciitis with genital involvement, resembling fournier gangrene.
BACKGROUND
Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process.


METHODS
We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge.


RESULTS
In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully.


CONCLUSIONS
Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.
Sugimoto
Motokazu
M
Department of Surgery, Okinawa Yaeyama Hospital, Okinawa, Japan . msugimot@east.ncc.go.jp
Matsuura
Kenji
K
Takayama
Hiroshi
H
Kayo
Munefumi
M
Ie
Tomotsugu
T
D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D004322:Drainage; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000473:pathology; D005832:Genital Diseases, Male / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000601:surgery; D012187:Retroperitoneal Space / Q000473:pathology*; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents