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.