Peristomal Necrotizing Fasciitis - Peculiar Evolution of a Patient with Metachronous Colonic Tumors
I.T. Marin, H. Doran, R. Zaharia, L. Lupu, T. Panazan, I. BrezeanClinical case, no. 5, 2014
We hereby present a case report of a patient with an unusualneoplasic and surgical history. M.V. is a 54-year-old patient whohad been operated, two years ago, for intestinal obstructioncaused by a sigmoid tumor; a segmental rectal and sigmoidresection (Hartmann's procedure) was then performed. Twoother surgical procedures were attempted during the last twoyears, in another surgical department: a colo-rectal anastomosisand a repair of the parastomal hernia, both failed due to postoperativeadhesions syndrome. The patient was hospitalized forperistomal gangrene with necrotizing fasciitis. Emergencyaction was taken to resolve the parietal gangrene. The postoperativelocal evolution of the wound was favourable andallowed a skin graft for parietal restoration. An intestinalobstruction occurred 2 months later, caused by an extendedmetachronous tumor of the splenic flexure. The patientunderwent other surgeries including the completion of the lefthemicolectomy, total gastrectomy, caudal splenopancreatectomyand left adrenalectomy. The patient has a favourable postoperativeevolution after 1 year.Conclusion: We noticed a very severe evolution of theperistomal gangrene and the rapid growth towards intestinalobstruction of the metachronous colonic tumor.
