Skip to main content
SpringerLink
Log in

Soft Tissue Necrotizing Infection Due to Perforated Colon

  • Chapter
  • First Online:
Complications in Acute Care Surgery

  • 1271 Accesses

Abstract

Necrotizing soft tissue infection caused by bowel perforation is uncommon. Failure to diagnose and treat it in a timely manner adds to the already significant associated mortality and morbidity. As with necrotizing soft tissue infections resulting from other causes, the initial presentation can be subtle. Laboratory studies and imaging may supplement clinical judgement to improve diagnostic accuracy. Once diagnosed antibiotics are promptly administered and urgent surgery performed. Prolonged resuscitation should not delay surgery. Spread to the gluteal region and thigh can occur. Evaluation with careful examination, imaging, and/or exploration might be required. Extensive debridements are the rule rather than the exception. Multiple procedures aimed at source control, removal of dead and infected tissue followed by wound stabilization are necessary. Long intensive care unit and hospital stays are standard. Post discharge rehabilitative services are required in all but a few patients. With comprehensive care that includes nutritional and physical therapy acceptable outcomes can be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Howell GM, Rosengart MR. Necrotizing soft tissue infections. Surg Infect (Larchmt). 2011;12(3):185–90.

    Article  Google Scholar 

  2. Morgan MS. Diagnosis and management of necrotizing faucitis: a multi parametric approach. J Hosp Infect. 2010;2010(75):249–57. doi:10.1016/j.jhin.01.028.

    Article  Google Scholar 

  3. Roje Z, Matic D. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World J Em Surg. 2011;6:46.

    Article  Google Scholar 

  4. Meyers M, Goodman K. Pathways of extrapelvic spread of disease: anatoic-radiologic correlation. AJR. 1975;125(4):900–9.

    Article  CAS  Google Scholar 

  5. Fiss T, Cigtay O, Miele A, Twigg H. Perforated viscus presenting with gas in the soft tissues (subcutaneous emphysema). AJR. 1975;125(1):226–33.

    Article  CAS  Google Scholar 

  6. Tsitsilonis S, Druschel C, Wichlas F, Haas NP, et al. Necrotizing fasciitis: is the bacteria spectrum changing? Langenbecks Arch Surg. 2013;398:153–9.

    Article  PubMed  Google Scholar 

  7. Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO, et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85(A):1454–60.

    Article  Google Scholar 

  8. Wall DB, Klein SR, Black S, de Virgilio C. A simple model to help distinguish necrotizing fasciitis from non-necrotizing soft tissue infection. J Am Coll Surg. 2000;191:227–31.

    Article  CAS  PubMed  Google Scholar 

  9. Stevens D, Bisno AL, Chamber HF, Everett ED, Dellinger P, et al. Management of skin and soft-tissue infections. Clin Infect Dis. 2005;41:1373–406.

    Article  PubMed  Google Scholar 

  10. Ecker KW, Baars A, Topfer J, Frank J. Necrotizing fasciitis of the perineum and the abdominal wall surgical approach. Eur J Trauma Emerg Surg. 2008;34:219–28.

    Article  PubMed  Google Scholar 

  11. Wong CH, Yam AK, Tan AG, Song C. Approach to debridement in necrotizing facitis. Am J Surg. 2008;196:19–24.

    Article  Google Scholar 

  12. Mueller TC, Loos M, Haller B, Mihaljevic AL, Nitsche U, Wilhelm D, et al. Intraoperative wound irrigation to reduce surgical site infection after abdominal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg. 2015;400:167–81.

    Article  PubMed  Google Scholar 

  13. Silberstein J, Grabowski J, Parsons JK. Use of a vacuum-assisted device for fournier’s gangrene: a new paradigm. Rev Urol. 2008;10:76–80.

    PubMed  PubMed Central  Google Scholar 

  14. Moues CM, vandenBemd GJ, Heule F, Hovius SE. Comparing conventional gauze therapy to vacuum-assisted closure wound therapy: a prospective randomized trail. J Plast Reconstr Aesthet Surg. 2007;60672–81. doi:10.1016/j.bjps.2006.01.041.

  15. Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg. 2014;1:36. doi:10.3389/fsurg.2014.00036.

  16. Piedra T, Martin-Cuesta L, Arnaiz J, Marco de Lucas E, Pellon R, Garcia-Bolado A, et al. Necrotizing fasciitis secondary to diverticulitis. Emerg Radiol. 2007;13:345–8.

    Article  PubMed  Google Scholar 

  17. Ecker KW, Baars A, Topfer J, Frank J. Necrotizing fasciitis of the perineum and the abdominal wall surgical approach. Eur J Trauma Emerg Surg. 2008;34:214–28.

    Google Scholar 

  18. Nisbet M, et al. Necrotizing fasciitis: review of 82 cases in South Auckland. Int Med J. doi:10.1111/j.1445-5994.2009.02137.

  19. Mulla ZD, Gibbs SG, Aronoff DM. Correlates of length of stay, cost of care and mortality among patients hospitalized for necrotizing fasciitis. Epidemiol Infect. 2007;135:868–76.

    Article  CAS  PubMed  Google Scholar 

  20. Tsitsilonis S, Durschel C, Wichlas F, Haas N, Schwabe P, Hermann J, et al. Necrotizing fasciitis: is the bacterial spectrum changing? Langenbecks Arch. 2013;398:153–9.

    Article  Google Scholar 

  21. Pessa ME, Howard RJ. Necrotizing fasciitis. Surg Gynecol Obstet. 1985;161:357–61.

    CAS  PubMed  Google Scholar 

  22. Bosshardt TL, Henderson VJ, Organ CH Jr. Necrotizing soft tissue infections. Arch Surg. 1996;131:846–55.

    Google Scholar 

  23. Eggerstedt M, Gamelli R, Mosier MJ. The care of necrotizing soft tissue infections: patterns of definitive intervention at a large referral center. J Burn Care Res. 2015;36(1):105–10.

    Article  PubMed  Google Scholar 

  24. Hakkarainen TW, et al. Curr Probl Surg. 2014;51:344–62.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Martinschek A, Evers B, Lampl L, Gerngrob H, Schmidt R, Sparwasser C. Prognostic aspects, survival rate, and predisposing risk factors in patients with fournier’s gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urol Int. 2012;89(2):173–9.

    Google Scholar 

  26. Vinh DH, Embil JM. Rapidly progressive soft tissue infections. Lancet Infect Dis. 2005;5:501–13.

    Article  PubMed  Google Scholar 

  27. Brook I. Mircrobiology and management of soft tissue and muscle infections. Int J Surg. 2008;6:328–38.

    Article  PubMed  Google Scholar 

  28. Paramythiotis D, Koukoutsis H, Harlaftis N. Necrotizing soft tissue infections. Surg Prac. 2007;11(1):17–28.

    Article  Google Scholar 

  29. Stevens DL, Bisno AL, Chambers HF, Patchen Dellinger E, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect. Dis. 2014;59(2).

    Google Scholar 

  30. Shimizu T, Tokunda Y. Necrotizing fasciitis. Int. Med. 2010;49:1051–57.

    Google Scholar 

  31. Wang JM, Lim KH. Necrotizing fasciitis: eight-year experience and literature review. Braz J Infect Dis. 2014;18(2):137–43.

    Article  PubMed  Google Scholar 

  32. Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. BJS. 2014;101:e119–25.

    CAS  Google Scholar 

  33. Childers BJ, Potyondy LD, Nachreiner R, Rogers FR, Childers ER, Oberg KC, Hendricks DL, Hardesty RA. Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive, patients. Am Surg. 2002;68:109–16.

    PubMed  Google Scholar 

  34. Lamagni TL, Neal S, Keshishian C, Alhaddad N, George R, Duckworth G, Vuopio-Varkila J, Efstratiou A. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis. 2008;14:2002–9.

    Article  Google Scholar 

  35. Sharkawy A, Low D, Saginur R, Gregson D, Schwartz B, Jessamine P, Green K, McGeer A. Severe group a Streptococcal soft-tissue in Ontario: 1992-1996. Clin Infect Dis. 2002;34:454–60.

    Article  PubMed  Google Scholar 

  36. Geusens E, Pans S, Van Breuseghem I, Knockaert D. Necrotizing fasciitis of the leg presenting with chest wall emphysema. Eur J Emerg Med. 2004;11:49–51.

    Article  PubMed  Google Scholar 

  37. Cox NH. Streptococcal necrotizing fasciitis and the dermatologist. Br J Dermatol. 1999;141:613–4.

    Article  CAS  PubMed  Google Scholar 

  38. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Faciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535–41.

    Article  PubMed  Google Scholar 

  39. Murphy G, Markeson D, Choa R, Armstrong A. Raised serum lactate: a marker of necrotizing fascitis? JPRSAS. 2013;66:1712–6.

    Google Scholar 

  40. Erol B, Tuncel A, Volkan H, Tokgoz H, Yildiz A, Akduman B, Kargi E, Mungan A. Fournier’s gangrene: overview of prognostic factors and definition of new prognostic parameter. Urology. 2010;75:1193–8.

    Article  PubMed  Google Scholar 

  41. Kinasewitz G, Zein J, Lee G, Nazir S, Taylor F. Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis. Crit Care Med. 2005;33(10):2214–21.

    Article  PubMed  Google Scholar 

  42. Fry DE. The prevention of surgical site infection in elective colon surgery. Scientifica. 2013;Article ID 896297:19.

    Google Scholar 

  43. Chundamal J, Wright JG. The efficacy and risks of using povidone iodine irrigation to prevent surgical site infection: an evidence-based review. Can J Surg. 2007;50:6.

    Google Scholar 

  44. Rodeheaver GT. Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Kane D, editors. Chronic wound care: a clinical source book for healthcare professionals. 2nd ed. Wayne: Health Management Publications, Inc.; 1997. p. 97–108.

    Google Scholar 

  45. Damm S. Intraoperative anaphylaxis associated with bactracin irrigation. Am J Health-Syst Pharm. 2011;68:323–7.

    Article  CAS  PubMed  Google Scholar 

  46. Rappaport WE, Holcomb M, Valente J, Chvapil M. Antibiotic irrigation and the formation of intraabdomincal adhesions. Am J Surg. 1989;158:435–7.

    Article  CAS  PubMed  Google Scholar 

  47. Yelon JA, Green JD, Evans JT. Efficacy of an intraperitoneal antibiotic to reduce the incidence of infection in the trauma patient: a prospective, randomized study. J Am Coll Surg. 1996;182:509–14.

    CAS  PubMed  Google Scholar 

  48. Nomikos IN, Katsouyanni K, Papaicannou AN. Washing with or without chloramphenicol in the treatment of peritonitis: a prospective, clinical trial. Surgery. 1986;99:20–5.

    CAS  PubMed  Google Scholar 

  49. Barnes S, Spencer M, Graham D, Johnson HB. Surgical wound irrigation: a call for evidence-based standardization of practice. Am J Infect Control. 2014;42:525–9.

    Article  PubMed  Google Scholar 

  50. Sakarya S, Gunay N, Karakulak M, Ozturk B, Ertugrul B. Hypochlorous acid: an ideal wound cre agent with powerful microbicidal, antibiolfilm and wound healing potency. Wounds. 2014;26(12):342–50.

    PubMed  Google Scholar 

  51. Guo S, Dipietro LA. Factors affecting wound healing. JDR. 2010;89(3):219–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Faraklas I, Stoddard GJ, Neumayer LA, Cochran A. Development and Validation of a Necrotizing Soft-Tissue Infection Mortality Risk Calculator Using NSQIP. J Am Coll Surg. 2013;217(1):153–60.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Program in Trauma, University of Maryland School of Medicine, University of Maryland Medical Center R A Cowley Shock Trauma Center, 22 South Greene Street, Baltimore, MD, 21201, USA

    Sharon M. Henry

Authors
  1. Sharon M. Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sharon M. Henry .

Editor information

Editors and Affiliations

  1. R Adams Cowley Shock Trauma Center Acute Care Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Jose J. Diaz

  2. Acute Care Surgery, John Hopkins Hospital Acute Care Surgery, Baltimore, Maryland, USA

    David T. Efron

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Henry, S.M. (2017). Soft Tissue Necrotizing Infection Due to Perforated Colon. In: Diaz, J., Efron, D. (eds) Complications in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42376-0_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42376-0_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42374-6

  • Online ISBN: 978-3-319-42376-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation