Open Abdomen Management for a Case of Retroperitoneal Necrotizing Fasciitis: A Case Report

Abstract

Retroperitoneal necrotizing fasciitis is a rarely encountered condition and is known to be associated with a high mortality rate, failing immediate and aggressive surgical management. Herein, we present a patient who underwent repeated surgical debridement and drainage under open abdomen management for early radical source control. A 60-year-old man with a history of diabetes mellitus and ulcerative colitis was transferred to our department because of disturbance of consciousness. On admission, he was diagnosed as having septic shock associated with retroperitoneal soft tissue infection caused by gas-forming bacteria, and presented with extensive emphysema in the abdomen and retroperitoneal space. At the time of laparotomy, the necrotic process extended from the left renal capsule to the retroperitoneum and mesentery. The patient was managed successfully by aggressive and repeated debridement under open abdomen management. On day 7, his abdomen was closed with a formal fascial suture, and he was transferred to a local hospital on day 78. In conclusion, in patients with retroperitoneal emphysema presenting with evidence of systemic inflammation, retroperitoneal necrotizing fasciitis should be considered, and open abdomen management may be a useful approach for aggressive radical source control in such cases.