Abstract / Summary
Abstract Introduction: Necrotizing soft-tissue infection (NSTI) is a rare, rapidly progressive, and potentially fatal surgical emergency. Early diagnosis is challenging due to its nonspecific presentation, and prompt recognition followed by urgent imaging and surgical intervention is essential to improve outcome. Case presentation: A 57 year old woman presented with generalized weakness, poor oral intake, lower abdominal pain, and oliguria. She was hypotensive, hypoxic, and in acute kidney injury with metabolic acidosis. Non-contrast CT revealed complicated sigmoid diverticulitis with extensive extraluminal gas extending through the left retroperitoneum, psoas, pelvis, and thigh, consistent with an extensive necrotizing soft-tissue infection. Emergency laparotomy with resection of the diseased sigmoid colon, upper rectum, distal ileum, and cecum, followed by end ileostomy and colostomy, was performed along with extensive left thigh exploration and debridement. Despite initial improvement following source control and intensive care, she developed wound infection with carbapenem-resistant Enterobacteriaceae and progressive hemodynamic deterioration, ultimately dying of cardiac arrest on postoperative day 19. Conclusion This case highlights the challenges of recognizing deep necrotizing infection from an intra-abdominal source, emphasizing the importance of early imaging and surgical source control.