Necrotizing fasciitis (NF) caused by
colorectal cancer is rare, and very few cases associated with
colon cancer have been reported. We describe the case of a patient with NF in the left thigh due to penetration of descending colon
cancer who was treated with one-stage surgical resection without creating a stoma.
CASE PRESENTATION: An 80-year-old woman was brought to our hospital complaining of
fever and difficulty with body movement. A physical examination showed
subcutaneous emphysema from the left lower abdomen to the left femoral region. CT showed
abscess formation with
emphysema around the descending colon, and the wall of the descending colon was thickened, which led to suspicion of
colon cancer. The patient was subsequently diagnosed with NF due to penetration of descending colon
cancer. Left
hemicolectomy and open drainage of the left femoral region was performed. The histopathological findings were well-differentiated
adenocarcinoma, with the
tumor grown through the serosa (T4a) and with no
metastasis to lymph nodes (N0). After surgery, the patient received
intensive care for
septic shock and lavage of the open drainage site, and
sepsis was controlled progressively. After closure of the drainage site, the patient was transferred to a different hospital at 26 days after surgery, and she has had 6-month relapse-free survival.
CONCLUSIONS: In NF caused by
colon cancer, early one-stage resection may improve the oncological outcome. Physical status should be assessed carefully, and one-stage resection should be considered if the patient has the capacity to undergo this procedure.