Presentation Information
[INTS1-5]A Case of Necrotizing Fasciitis Caused by Penetration of a Sigmoid Diverticulum Treated with Surgery and NPWT
*Haruka Kanai1, Daisuke Inagaki1, Kenichi Kamachi1, Seigi Lee1, Yoshihito Masuoka1, Mie Tanabe1 (1. Department of Surgery, Tokyo Shinagawa Hospital, Japan)
Abstract: A 64-year-old woman presented with a one-month history of abdominal pain was transferred to our hospital for further evaluation and treatment. She had previously received broad-spectrum antibiotics for two days at a local hospital, but her symptoms worsened and inflammatory markers increased. On arrival at our hospital, the patient exhibited hypotension and hypoxemia. Physical examination revealed tenderness, muscular guarding, and slight erythema extending from the lower abdomen to the left flank. Computed tomography demonstrated penetration of sigmoid diverticulum, extensive soft tissue emphysema and fat stranding throughout the subcutaneous tissue in the left lower abdominal quadrant. On the day of admission, emergency subcutaneous irrigation, debridement, and drainage were performed under general anesthesia for necrotizing fasciitis to control the rapidly progressing infection. Continuous irrigation was subsequently administered through drains. On hospital day 23, sigmoidectomy and double-barrel ileostomy were performed. Oral intake was resumed on hospital day 32, and the postoperative course was uneventful. Daily wound irrigation was continued, followed by initiation of negative pressure wound therapy (NPWT) on hospital day 67. The patient recovered favorably and was discharged on hospital day 87. Stoma closure is planned at a later date.
Discussion: Necrotizing fasciitis is a rapidly progressive soft tissue infection with a high mortality rate. Early diagnosis and prompt surgical intervention are essential for survival. We report a rare case of necrotizing fasciitis caused by penetration of a sigmoid diverticulum. Rapid debridement was performed, followed by staged partial colectomy, and the patient was successfully treated with wound irrigation and negative pressure wound therapy (NPWT). This case is discussed in the context of the relevant literature.
Discussion: Necrotizing fasciitis is a rapidly progressive soft tissue infection with a high mortality rate. Early diagnosis and prompt surgical intervention are essential for survival. We report a rare case of necrotizing fasciitis caused by penetration of a sigmoid diverticulum. Rapid debridement was performed, followed by staged partial colectomy, and the patient was successfully treated with wound irrigation and negative pressure wound therapy (NPWT). This case is discussed in the context of the relevant literature.