Necrotzing fasciitis due to a perforated adenocarcinoma of the splenic flexure
Presentation
Permament indwelling urinary catheter. Left-sided groin pain and fever ? urosepsis
Patient Data
Annular mass of the proximal descending colon.
CT 6 months later
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 hematogenous 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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