A CASE OF NECROTIZING FASCIITIS AFTER THE SURGERY FOR ILEUS DUE TO SIGMOID COLON CANCER

Necrotizing fasciitis is a rare and rapidly progressing bacterial infection, which rarely develops after surgical procedures for gastrointestinal disease without perforation. We successfully treated a 75-year-old male patient with this disorder following surgery for ileus due to sigmoid colon cancer. The ileus had been operated on with a sigmoid colon resection and primary anastomosis. Two days after surgery, subcutaneous emphysema occurred in the right lower abdomen, spreading 3 days after surgery to the right femoral area, and necrosis and swelling gradually advanced. Because disseminated intravascular coagulation occurred 8 days after surgery, the patient was transferred to another hospital with an intensive care unit. An exploratory laparotomy performed the same day revealed no abnormal findings in the peritoneal cavity; however, the right lower limb and right lateral abdomen contained extensive purulent fluid in the subcutaneous fat layer. A necrosectomy and open drainage were emergently performed, and the patient gradually recovered from the septic state. Culture of the purulent secretions and circulating blood showed Providencia rettgeri, an enterobacterium. Necrotizing fasciitis is usually fatal if adequate surgical treatment is delayed. Surgeons should keep in mind possibility of postsurgical necrotizing fasciitis in gastrointestinal surgery cases.