Necrotizing Fasciitis Originating from Metastatic Colorectal Tumor Invasion-Case Report

Abstract

Background: Retroperitoneal necrotizing fasciitis is a rare, fulminate disease, and is often fatal. The etiology of retroperitoneal necrotizing fasciitis may be the result of pelvic or perirectal infection, including those of the gynaecologic and obstetric origin, colonic inflammatory disease, or even due to a ruptured appendix. Aim and Objectives: We present two cases with retroperitoneum and lower extremities necrotizing fasciitis and diagnosed as caused by colorectal adenocarcinoma invasion. We aim to discuss the rare etiology, clinical presentation, diagnosis and treatment. Materials and Methods: We present two cases report with initial presentation of retroperitoneal necrotizing fasciitis, and diagnosed as caused by colorectal adenocarcinoma invasion. Due to severe sepsis, the first patient died on day 73 after emergent fasciotomy and debridement. The second patient who received left hemicolectomy, several courses of debridement, and skin graft was discharged in good health after 60 days. Results: In a review of the current literature, only a few reported cases have presented with retroperitoneal necrotizing fasciitis directly caused by the colorectal cancer. Almost all of the patients in the previously published reports expired during the fulminate course of infection. Our second patient was one of the few cases who successful survived after cancer treatment and reconstruction. Conclusion: Extended necrotizing fasciitis including Fournier's gangrene is a potentially lethal infectious disease. Direct tumor invasion is a rare cause, but results in higher mortality from the disease. If we can provide an early diagnosis via tumor markers, image, or biopsy, we may treat the underlying disease, thereby reducing the number of operations and further improving the outcome. We also should keep in mind that extended necrotizing fasciitis of the groin areas, abdominal wall, and perineum may be related to metastatic tumor invasion.