2025 Volume 58 Issue 10 Pages 612-621
A 53-year-old woman with colonic obstruction secondary to sigmoid colon cancer was transferred to our hospital. Despite being concurrently diagnosed with coronavirus disease (COVID-19), urgent bowel decompression was necessary, and sigmoid colostomy was performed on the day of admission. On postoperative day (POD) 2, erythema was noted around the stoma, which progressed to a black discoloration by POD 4, raising concerns of necrotizing fasciitis. On POD 5, the necrotic abdominal wall, including the stoma site, was extensively resected. This was followed by reconstruction with an ileostomy, a sigmoid mucosal fistula, and abdominal wall repair using a musculocutaneous flap. Histopathological examination revealed extensive necrosis of the skin and subcutaneous tissues. In the postoperative period, progressive purpura developed around the reconstructed abdominal walls. However, no further necrosis was observed after administration of fresh frozen plasma and heparin. The patient’s condition gradually improved, and she was discharged in a stable condition on POD 40. Peristomal infections following colostomy have been reported in 0.9–8% of cases, but rapid progression to necrotizing soft tissue infection is rare. In this case, the COVID-19-associated hypercoagulable state may have contributed to the pathogenesis.
