Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer

Ju-Oh Kim; Hong-Man Cho; Woo-Jin Sin; Hwang-Se Bong

doi:10.5371/hp.2013.25.2.149

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Kim, Cho, Sin, and Bong: Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer

Case Report

Hip & Pelvis 2013; 25(2): 149-152.

Published online: 30 June 2013

DOI: https://doi.org/10.5371/hp.2013.25.2.149

Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer

Ju-Oh Kim, MD, Hong-Man Cho, MD, Woo-Jin Sin, MD, Hwang-Se Bong, MD

Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea.

Address reprint request to Hong-Man Cho, MD. Department of Orthopedic Surgery, Gwangju Veterans Hospital, 887-1 Sanwol-dong, Gwangsan-gu, Gwangju 506-705, Korea. TEL: +82-62-602-6162, FAX: +82-62-602-6164, chm1228@hanmail.net

Received 4 May 2013 Revised 21 June 2013 Accepted 21 June 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Necrotizing fasciitis is one of the few true emergencies in orthopedic surgery that has a very high mortality rate unless recognized promptly and treated aggressively.

The authors report a case of a patient with necrotizing fasciitis on the thigh that developed secondary to an unrecognized rectal cancer perforation through the short external rotator muscles. Clinicians should always be alert to the potential that rectal cancer perforations can cause necrotizing fasciitis in rare cases.

Keywords: Necrotizing fascitis, Rectal cancer, Perforation, Thigh

Figures and Tables

Fig. 1

(A) An initial radiograph shows subcutaneous emphysema of the thigh. (B) CT reveals subcutaneous emphysema involving the soft tissues of the left thigh and fluid collections most compatible with abscesses.

Fig. 2

An intraoperative photograph shows purulent pus discharge from the wound and necrosis of fascia, infiltration of pus along the fascial plane and vastus lateralis muscle.

Fig. 3

Abdominopelvic CT shows a rectal malignancy with lymph nodes in perirectal space and inferior mesenteric chain and multiple abscess pockets in left pelvis & scanned thigh muscles with fistula.

References

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2. Fontes RA Jr, Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg. 2000; 8:151–158.

3. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003; 85-A:1454–1460.

4. Highton L, Clover J, Critchley P. Necrotising fasciitis of the thigh secondary to a perforated rectal cancer. J Plast Reconstr Aesthet Surg. 2009; 62:e17–e19.

5. Park SH, Choi JR, Song JY, et al. Necrotizing fasciitis of the thigh secondary to radiation colitis in a rectal cancer patient. J Korean Soc Coloproctol. 2012; 28:325–329.

6. Saldua NS, Fellars TA, Covey DC. Case report: Bowel perforation presenting as subcutaneous emphysema of the thigh. Clin Orthop Relat Res. 2010; 468:619–623.

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