title: Necrotising fasciitis secondary to perforated rectal adenocarcinoma presenting as a thigh swelling.
abstract: A 62-year-old man was admitted to the medical admissions ward with right thigh pain presumed to be a deep vein thrombosis (DVT). Subsequent duplex ultrasonography excluded a DVT but noted the presence of a significant amount of subcutaneous gas. A plain film radiograph was performed with the same finding raising the possibility of necrotising fasciitis (NF). Only at this point was digital rectal examination performed revealing a large rectal mass oozing pus and blood. CT imaging showed thickening of the rectum consistent with a tumour with gas and fluid in the perirectal space extending to the anterolateral right femur. Despite aggressive debridement and treatment, the patient deteriorated and died 6 weeks later. This case should serve as a reminder to consider digital rectal examination and the occurrence of a rectal perforation in all patients who present with suspicious thigh swellings.
authors.affiliation: Department of Surgery, Pennine Acute Hospitals Trust, Manchester, UK.
authors.forename: William David George
authors.initials: WD
authors.lastname: Evans
authors.affiliation: Department of Gastroenterology, Pennine Acute Hospitals Trust, Oldham, UK.
authors.forename: Conchubhair
authors.initials: C
authors.lastname: Winters
authors.affiliation: Department of Surgery, Royal Oldham Hospital, Oldham, UK.
authors.forename: Eshan
authors.initials: E
authors.lastname: Amin
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D051517:Digital Rectal Examination; D004487:Edema / Q000209:etiology*; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013848:Thigh
chemical_list: D000900:Anti-Bacterial Agents
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