2018 Volume 51 Issue 10 Pages 656-662
A 79-year-old woman underwent sigmoid colectomy with end colostomy, peritoneal lavage and drainage for pan-peritonitis of perforated sigmoid colon cancer. Although preoperative CT revealed left obturator hernia, no incarceration of the intestine occurred, and hence, no treatment was performed for obturator hernia. On postoperative day 45, significant swelling and pain in the left thigh was noted. Subsequently, CT revealed an extensive abscess from around the left obturator foramen to the thigh. This condition was complicated with necrotizing fasciitis of the thigh muscles, requiring an urgent debridement procedure. Later, another debridement procedure, negative pressure closure therapy, and split-thickness skin grafts were required. Based on the evidence, the patient was given a diagnosis of residual abscess formed in the obturator hernia sac spread to the thigh. To the best of our knowledge, this is the first report of a patient in whom a residual abscess was formed in the coexisting obturator hernia sac after surgery for gastrointestinal perforation. Thus, based on our experience, we suggest that if peritonitis coexists with hernia, possible complication of femoral abscess or necrotizing fasciitis should be considered and a prophylactic treatment suitable for residual abscess should be adopted.
