Necrotzing fasciitis due to a perforated adenocarcinoma of the splenic flexure

Case contributed by Dr Chris O'Donnell

Presentation

Permament indwelling urinary catheter. Left-sided groin pain and fever ? urosepsis

Patient Data

Age: 80 years
Gender: Male

Annular mass of the proximal descending colon.

In the splenic flexure (at the site of annular constricting mass on CT scan performed 6 months previously - arrow) there is a large mass containing gas (arrow) consistent with a perforated colonic neoplasm and abscess.  Interestingly there is no associated large bowel obstruction.  Gas is also present within the muscle fibers of the left groin and lateral pelvic wall (arrow).  This is not obviously in direct communication with the splenic flexure lesion thus may represent haematogenous spread of infection by gas-forming organisms

Case Discussion

Necrotizing fasciitis is a severe soft tissue infection usually due Group A beta hemolytic Strep. although other organisms can be responsible.  It is life-threatening thus the detection of gas in soft tissues is an important finding together with swellling and edema.

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Case information

rID: 46930
Published: 24th Jul 2016
Last edited: 16th Aug 2019
Inclusion in quiz mode: Excluded

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