Clin Endosc.  2021 Mar;54(2):280-284. 10.5946/ce.2020.117.

Fatal Necrotizing Fasciitis Following Uncomplicated Colonoscopic Polypectomy: A Case Report

• Chae MK
• Shin SY
• Kwak MS
• Yoon JY
• Kim HI
• Cha JM

• KMID: 2514185
• DOI: http://doi.org/10.5946/ce.2020.117

Abstract

Necrotizing fasciitis (NF) is a life-threatening infection that can be caused by various procedures or surgery and may develop in healthy elderly patients. Here, we report a case of a 66-year-old man with diabetes mellitus who underwent colonoscopic polypectomy, without complications. However, he visited the emergency department 24 hours after the procedure complaining of abdominal pain. Abdominopelvic computed tomography revealed multiple air bubbles in the right lateral abdominal muscles. After a diagnosis of NF was made, immediate surgical debridement was performed. However, despite three sessions of extensive surgical debridement and best supportive care at the intensive care unit, the patient died because of sepsis and NF-associated multiple-organ failure. In conclusion, physicians should pay special attention to the possibility of NF if a patient with risk factors for NF develops sepsis after colonoscopic polypectomy.

Keyword

Colonoscopy; Diabetes mellitus; Necrotizing fasciitis; Sepsis

Figure

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  Fig. 1. Colonoscopic findings of endoscopic mucosal resection of a polyp in the ascending colon.

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  Fig. 2. Abdominopelvic computed tomography scan showing swelling of the right lateral abdominal muscles with multiple air bubbles (white arrow and white triangle) in muscles. (A) Axial view, (B) coronal view.

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  Fig. 3. (A) Gross findings of the abdomen, before the first surgical debridement, showing bullae formation and necrosis with dusky discoloration. (B) The first surgical debridement—performed with Penrose drainage and betadine-soaked gauze dressing.

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  Fig. 4. (A) Gross findings of the second surgical debridement showing increased drainage site with abscess and dirty fluid discharge. (B) The third surgical debridement showing a wide and deep necrosis and edema.

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