Presentation Information
[INTS1-4]Retroperitoneal Necrotizing Fasciitis Extending to the Para-esophageal Space after Procedure for Prolapse and Hemorrhoids (PPH)
*Zhiyin Deng1, Shiwei Chen2 (1. Department of Proctology, The Affiliated Guangzhou Hospital of Traditional Chinese Medicine of Guangzhou University of Chinese Medicine, China, 2. The Affiliated Traditional Chinese Medicine Hospital of Guangzhou Medical University, China)
Background
Necrotizing fasciitis (NF) after procedure for prolapse and hemorrhoids (PPH) is rare but may progress rapidly with high morbidity and mortality. Retroperitoneal extension to the mediastinum after anorectal surgery is exceptional.
Case Presentation
A 35-year-old man with mixed hemorrhoids and anemia underwent PPH. On postoperative day (POD) 4, he developed fever, progressing to septic shock by POD 9, accompanied by exacerbated perianal pain, increased purulent discharge, and lower abdominal pain. His medicial history included a 2025 myocardial infarction (balloon angioplasty), coronary artery disease, hypertension, and hyperlipidemia. Antiplatelet therapy was discontinued one week before PPH.
Admission laboratory tests revealed marked systemic inflammation, anemia, and hypoalbuminemia: WBC 21.60×10⁹/L, Hb 74g/L, albumin 29.1g/L, PCT 1.40ng/mL, IL-6 163.8pg/mL, and CRP182.9 mg/L. Chest-abdominal CT showed extensive gas in perirectal and abdominopelvic retroperitoneal spaces, extending to the para-esophageal region.
Emergency surgery within 6 hours included laparoscopic transverse colostomy, rectal fistula repair, extensive debridement, and drainage. Postoperatively, the patient received intensive care, mechanical ventilation, and broad-spectrum antibiotics. Purulent fluid culture grew E. coli susceptible to imipenem, ertapenem, cefoperazone/sulbactam, and tigecycline. After repeated wound care and multidisciplinary treatment, infection resolved and the patient recovered.
Discussion and Conclusion
Persistent fever and progressive pain after PPH may signal deep pelvic infection with retroperitoneal spread. When symptoms are disproportionate to the expected course, early CT enables prompt diagnosis. Timely fecal diversion, extensive debridement, adequate drainage, targeted antibiotics, and multidisciplinary intensive care are crucial for favorable outcomes. This case underscores the catastrophic progression of an anorectal anastomotic leak and highlights the importance of early recognition and aggressive surgery.
Necrotizing fasciitis (NF) after procedure for prolapse and hemorrhoids (PPH) is rare but may progress rapidly with high morbidity and mortality. Retroperitoneal extension to the mediastinum after anorectal surgery is exceptional.
Case Presentation
A 35-year-old man with mixed hemorrhoids and anemia underwent PPH. On postoperative day (POD) 4, he developed fever, progressing to septic shock by POD 9, accompanied by exacerbated perianal pain, increased purulent discharge, and lower abdominal pain. His medicial history included a 2025 myocardial infarction (balloon angioplasty), coronary artery disease, hypertension, and hyperlipidemia. Antiplatelet therapy was discontinued one week before PPH.
Admission laboratory tests revealed marked systemic inflammation, anemia, and hypoalbuminemia: WBC 21.60×10⁹/L, Hb 74g/L, albumin 29.1g/L, PCT 1.40ng/mL, IL-6 163.8pg/mL, and CRP182.9 mg/L. Chest-abdominal CT showed extensive gas in perirectal and abdominopelvic retroperitoneal spaces, extending to the para-esophageal region.
Emergency surgery within 6 hours included laparoscopic transverse colostomy, rectal fistula repair, extensive debridement, and drainage. Postoperatively, the patient received intensive care, mechanical ventilation, and broad-spectrum antibiotics. Purulent fluid culture grew E. coli susceptible to imipenem, ertapenem, cefoperazone/sulbactam, and tigecycline. After repeated wound care and multidisciplinary treatment, infection resolved and the patient recovered.
Discussion and Conclusion
Persistent fever and progressive pain after PPH may signal deep pelvic infection with retroperitoneal spread. When symptoms are disproportionate to the expected course, early CT enables prompt diagnosis. Timely fecal diversion, extensive debridement, adequate drainage, targeted antibiotics, and multidisciplinary intensive care are crucial for favorable outcomes. This case underscores the catastrophic progression of an anorectal anastomotic leak and highlights the importance of early recognition and aggressive surgery.