Thigh Abscess Secondary to Intra-Abdominal Pathologic Conditions

Three Cases Progressing to Necrotizing Fasciitis

Arife Simsek, MD

Disclosures

Wounds. 2021;33(9):226-230. 

In This Article

Abstract and Introduction

Abstract

Introduction: Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection.

Objective: This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis.

Materials and Methods: The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented.

Results: All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis.

Conclusions: Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.

Introduction

Necrotizing fasciitis (NF) is a progressive destruction of the fascia and overlying tissue.[1] It does not arise de novo; rather, it emerges as a result of infection.[1] Mortality primarily depends on the timing of medical care and the extent of the infection.[1,2] A significant diagnostic challenge leading to misdiagnosis of NF is the normal appearance of the overlying skin; in fact, the infection is located deeper in the soft tissues.

Thigh abscesses are relatively rare and often spontaneously arise from surrounding soft tissues; however, they may also occur secondary to intraperitoneal, retroperitoneal, and pelvic pathologic conditions.[3–5] The mortality rate associated with thigh abscesses arising from intra-abdominal pathologic conditions was reported to be 34% when both the intra-abdominal pathologic condition and the thigh abscess were treated.[4] However, a mortality rate of 93% was reported in cases that were managed locally without attention to the underlying causes.[4] This article presents a case series of thigh abscesses that originated from intra-abdominal pathologic conditions and progressed to NF owing to a delay in diagnosis.

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