Case report:
A 76-year-old male patient, with no medical history, presented to the
emergency department with swelling of the inner side of his left thigh.
On physical examination, the patient was febrile at 38°C, Glasgow coma
scale at 14/15. Blood pressure was 8/4 cm Hg, heart rate was 125 bpm.
The patient had polypnea at 25c/min. He had a swelling measuring 15cm in
the inner side of his left thigh with skin necrosis and inflammatory
signs. The abdomen was soft and not painful. However, there was a
swelling measuring 5 cm in the left inguinal region with inflammatory
signs. Computed tomography (CT) angiography of the lower limb showed
fluid and gas tracking along fascial plans of the left thigh extended
over 30 cm (Figure 1). The diagnosis of septic shock related to
necrotizing fasciitis of the left thigh and abdominal wall was retained
and we decided to operate the patient under general anesthesia. Since
the induction the patient presented a drop in blood pressure with
tachycardia at 150 bpm requiring high doses of catecholamine.
In the first step, we started with an incision in the left inner thigh.
About 100 milliliters of pus was removed. Dissection into quadriceps
muscle plans allowed drainage of 200 milliliters of pus with necrotic
debris which were excised. In the second step, we proceed by incision in
the left inguinal region. Dissection into muscle plans allowed drainage
of 100 milliliters of pus with necrotic debris. In the third step, an
abdominal midline incision was made. We discovered a 5 cm tumor in the
sigmoid based on iliac arterial bifurcation: it was perforated in the
retroperitoneum (Figure 2). The tumor was unresectable, we only
performed a colostomy in the left flank with a biopsy of the tumor.
Pathological examination of the specimen showed a well differentiated
Lieberkuhnian adenocarcinoma. Bacteriological examination of the pus
showed E. coli multi drug-sensitive. Due to septic shock and despite the
aggressive debridement of necrotic tissues, high doses of intravenous
antibiotics and intensive care support, the patient deceased one day
after surgery.