Robbie Elliot, Desai Seema, Ramavath Ashok
Obstetrics and Gynaecology, Lewisham and Greenwich NHS Trust, London, UK
Trauma and Orthopaedics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
BMJ Case Rep. 2024 Dec 18;17(12):e262470. doi: 10.1136/bcr-2024-262470.
Necrotising fasciitis (NF) is a rare surgical emergency characterised by soft tissue necrosis and systemic compromise. Typically it originates following adjacent skin and soft tissue insult; however, our unusual case required a high index of clinical suspicion to avert potential mortality. A man in his 60s with diabetes mellitus presented with 2 weeks of knee pain, swelling and necrotic skin on the posterior calf. X-ray demonstrated subcutaneous emphysema. Initial debridement confirmed extensive necrotising fasciitis of the whole lower limb with tracking through femoral canal into the abdomen. CT confirmed sigmoid colon perforation. Both life-saving Hartmann's and hip disarticulation procedures were performed with good outcomes. Histology confirmed locally invasive sigmoid colon adenocarcinoma. Our case highlights lower limb necrotising fasciitis as a rare complication secondary to sigmoid perforation associated with malignancy. In cases where the infection nidus cannot be identified, an abdominal source should be considered.
坏死性筋膜炎（NF）是一种罕见的外科急症，其特征为软组织坏死和全身功能障碍。通常它继发于邻近的皮肤和软组织损伤；然而，我们这个不寻常的病例需要高度的临床怀疑才能避免潜在的死亡。一名60多岁的糖尿病男性患者，出现膝关节疼痛、肿胀以及小腿后侧皮肤坏死2周。X线显示皮下气肿。初步清创证实整个下肢广泛坏死性筋膜炎，并经股管蔓延至腹部。CT证实乙状结肠穿孔。同时进行了挽救生命的哈特曼手术和髋关节离断术，效果良好。组织学证实为局部浸润性乙状结肠腺癌。我们的病例强调了下肢坏死性筋膜炎是与恶性肿瘤相关的乙状结肠穿孔继发的罕见并发症。在无法确定感染灶的情况下，应考虑腹部来源。
