title: [Complicated diverticular disease debuting as necrotising fasciitis of pelvic limb. A case report].
abstract: BACKGROUND
  Diverticular disease, and the diverticulitis, the main complication of it, are widely studied diseases with multiple chronic cases reported in the literature, but there are no atypical presentations with extra-abdominal symptoms coupled with seemingly unrelated entities, such as necrotising fasciitis.
  
  
  METHODS
  Female 52 years old, was admitted to the emergency department with back pain of 22 days duration. History of importance: Chronic use of benzodiazepines intramuscularly. Physical examination revealed the presence of a gluteal abscess in right pelvic limb with discoloration, as well as peri-lesional cellulitis and crepitus that stretches across the back of the limb. Fasciotomy was performed with debridement of necrotic tissue. Progression was torpid with crackling in abdomen. Computed tomography showed free air in the cavity, and on being surgically explored was found to be complicated diverticular disease.
  
  
  CONCLUSIONS
  It is unusual for complicated diverticular disease to present with symptoms extra-peritoneal (< 2%) and even more so that a diverticulitis is due to necrotising fasciitis (< 1%). The absence of peritoneal manifestations delayed the timely diagnosis, which was evident with the crackling of the abdomen and abdominal computed tomography scan showing the parietal gaseous process.
  
  
  CONCLUSIONS
  All necrotising fasciitis needs an abdominal computed tomography scan to look for abdominal diseases (in this case diverticulitis), as their overlapping presentation delays the diagnosis and consequently the treatment, making a fatal outcome inevitable.
authors.affiliation: Servicio de Cirugía General, Hospital Dr. Valentín Gómez Farías, Zapopan, Jalisco, México. Electronic address: cuauhtly@hotmail.com.
authors.forename: Cuauhtly
authors.initials: C
authors.lastname: Gallegos-Sierra
authors.affiliation: Servicio de Cirugía General, Hospital Dr. Valentín Gómez Farías, Zapopan, Jalisco, México.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gutiérrez-Alfaro
authors.affiliation: Servicio de Cirugía General, Hospital Dr. Valentín Gómez Farías, Zapopan, Jalisco, México.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Evaristo-Méndez
mesh_terms: D000038:Abscess / Q000150:complications; D002081:Buttocks; D002481:Cellulitis / Q000209:etiology; D003646:Debridement; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000601:surgery; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D000071938:Fasciotomy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D007866:Leg; D017116:Low Back Pain / Q000209:etiology; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D014057:Tomography, X-Ray Computed
keywords: Abdominal; Computed tomography; Diverticulitis; Extra-peritoneal; Extraperitoneal; Fascitis necrosante; Necrotising fasciitis; Tomografía computada