Staged reconstruction of challenging abdominal full thickness wounds caused by necrotizing fasciitis and complicated by occult rectal cancer—a rare combination

A 61-year-old woman developed neorectal prolapse after laparoscopic low anterior resection, total mesorectal excision with partial intersphincteric resection and handsewn coloanal anastomosis for rectal cancer. She presented with a 3 cm full thickness reducible prolapse, with associated anal pain and bleeding. A perineal stapled prolapse resection was performed to address the rectal prolapse, with satisfactory results.

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Full-thickness neorectal prolapse after transanal transabdominal proctosigmoidectomy for low rectal cancer: a cohort study

Colorectal Disease ◽

10.1111/codi.14030 ◽

2018 ◽

Vol 20 (7) ◽

pp. 593-596 ◽

Cited By ~ 4

Author(s):

M. Guraieb-Trueba ◽

A. R. Helber ◽

J. H. Marks

Keyword(s):

Rectal Cancer ◽

Cohort Study ◽

Low Rectal Cancer ◽

Full Thickness

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Endoscopic full-thickness resection for T1 early rectal cancer: a case series and video report

Endoscopy International Open ◽

10.1055/s-0043-118657 ◽

2017 ◽

Vol 05 (11) ◽

pp. E1081-E1086 ◽

Cited By ~ 10

Author(s):

Paola Soriani ◽

Gian Tontini ◽

Helmut Neumann ◽

Germana de Nucci ◽

Domenico De Toma ◽

...

Keyword(s):

Rectal Cancer ◽

Endoscopic Resection ◽

Surgical Approach ◽

Case Series ◽

Disease Recurrence ◽

Colorectal Polyps ◽

Early Rectal Cancer ◽

Full Thickness ◽

En Bloc

Abstract Background and study aims Endoscopic treatment of malignant colorectal polyps is often challenging, especially for early rectal cancer (ERC) localized close to the dentate line. Conversely, the surgical approach may result in temporary or definitive stoma and in frequent post-surgical complications. The Full-Thickness Resection Device (FTRD®) System (Ovesco Endoscopy, Tübingen, Germany) is a novel system that, besides having other indications, appears to be promising for wall-thickness excision of intestinal T1 carcinoma following incomplete endoscopic resection. However, follow-up data on patients treated with this device are scarce, particularly for ERC. Patients and methods Six consecutive patients with incomplete endoscopic resection of T1-ERC were treated with the FTRD and their long-term outcomes were evaluated based on a detailed clinical and instrumental assessment. Results The endoscopic en bloc full-thickness resection was technically feasible in all patients. The histopathologic analysis showed a complete endoscopic resection in all cases, and a full-thickness excision in four. Neither complications, nor disease recurrence were observed during the 1-year follow-up period. Conclusions The FTRD System is a promising tool for treating ERC featuring a residual risk of disease recurrence after incomplete endoscopic mucosal resection in patients unfit for surgery or refusing a surgical approach.

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Necrotizing fasciitis as an initial manifestation of perforated rectal cancer in a young man

Journal of Acute Medicine ◽

10.1016/j.jacme.2012.05.003 ◽

2012 ◽

Vol 2 (2) ◽

pp. 62-64 ◽

Cited By ~ 1

Author(s):

Henry Chih-Hung Tai ◽

Chung-Tai Yao ◽

Wei-Lung Chen ◽

Jiann-Hwa Chen ◽

Ying-Sheng Shen

Keyword(s):

Rectal Cancer ◽

Necrotizing Fasciitis ◽

Initial Manifestation

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Anorectal and sexual functions after preoperative radiotherapy and full-thickness local excision of rectal cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2013.11.010 ◽

2014 ◽

Vol 40 (6) ◽

pp. 723-730 ◽

Cited By ~ 33

Author(s):

A. Gornicki ◽

P. Richter ◽

W. Polkowski ◽

M. Szczepkowski ◽

L. Pietrzak ◽

...

Keyword(s):

Rectal Cancer ◽

Local Excision ◽

Preoperative Radiotherapy ◽

Full Thickness

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Incidence and severity of postoperative complications following neoadjuvant therapy and full-thickness local excision for moderately advanced rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15167 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15167-e15167

Author(s):

Ahmed Abdalla ◽

Amr Aref ◽

Amer Alame ◽

Mohammed Barawi ◽

Abdelkader Hawasl ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Therapy ◽

Local Excision ◽

Organ Preservation ◽

Advanced Rectal Cancer ◽

Dentate Line ◽

Fistula Formation ◽

Full Thickness ◽

Operative Complications ◽

Post Operative Complications

e15167 Background: Trans-anal full-thickness local excision (LE) for patients with moderately advanced rectal cancer (MARC) whose tumors respond well to neoadjuvant therapy, is one approach for organ preservation. Some authors call for abandoning this procedure because it causes frequent and severe complications. We aim to report our post-operative complications rate and severity following this procedure. Methods: This is a retrospective review of the complications observed in 10 patients who underwent LE at our center between May 2017-January 2019. Primary outcomes were the presence and nature of complications associated with the treatment course. Results: Five patients were treated according to Phase II trial and received three months of FOLFOX chemotherapy followed by concurrent chemo-RT. Five additional patients received only concurrent chemo-radiotherapy as they were treated off protocol. Radiation therapy (RT) dose ranged between 45-54 Gy and the interval between completion of RT and LE ranged between 6-15 weeks; median 11.5 weeks. Gross residual disease was resected with no margin in nine patients. The size of removed specimens ranged between 6.8-1.4cm; median 2.2 cm with a depth of resection of 1.5-0.4 cm; median .6 cm. Two patients had a very low residual gross abnormality and the surgical resection extended to the dentate line. Both patients experienced grade III complications of severe pain, infection and fistula formation. Of the remaining 8 patients with tumors located between 3-8 cm from the anal verge, two patients developed grade II complications requiring a short course of antibiotics and symptomatic treatment. In both cases, symptoms resolved within one week. Conclusions: Post-operative complications in this setting are not prohibitive if LE doesn’t extend to the dentate line and the resection is limited to only residual abnormality with no mucosal margin. A complete pathological response, confirmed by LE after neoadjuvant therapy provides valuable prognostic information and can influence the intensity and burden of future follow up. The risk of surgical complications is acceptable in view of these advantages. LE remains a viable option in pursuing organ preservation for MARC when complete remission is achieved by neoadjuvant therapy.

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Necrotizing fasciitis of the thigh should raise suspicion of a rectal cancer

Journal of Visceral Surgery ◽

10.1016/j.jviscsurg.2010.07.003 ◽

2010 ◽

Vol 147 (3) ◽

pp. e187-e189 ◽

Cited By ~ 8

Author(s):

H. Khalil ◽

B. Tsilividis ◽

L. Schwarz ◽

M. Scotté

Keyword(s):

Rectal Cancer ◽

Necrotizing Fasciitis

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Necrotizing Fasciitis of the Cheek: A Case Report

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2017-0030 ◽

2017 ◽

Vol 34 (3) ◽

pp. 247-252

Author(s):

Vojkan Lazić ◽

Dragan Krasić ◽

Miloš Trajković ◽

Miloš Stojanović ◽

Nikola Živković ◽

...

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Necrotizing Fasciitis ◽

Soft Tissues ◽

Early Recognition ◽

The Body ◽

Left Cheek ◽

Full Thickness ◽

Life Threatening ◽

Subcutaneous Tissues

SummaryThe term necrotizing fasciitis (NF) was first used by Wilson in 1952, who described this rare, however, progressive infection that primarily affects the fascia and subcutaneous tissues. Necrotizing fasciitis may affect any part of the body; however, it usually appears on the extremities. The most common microorganisms isolated in NF areStaphylococcus aureus, groupA Streptococci, andEscherichia Coli.We are presenting the case of a sixty-seven-year old woman, who was admitted for the perforation of painful edema of the left cheek. Clinical examination of the anterior two-thirds of the left cheek revealed a defect of the full thickness of the skin, 3×4 cm in size. During the patient’s hospitalization she was treated by parenterally administered broad-spectrum antibiotics, necrotomy, fasciotomy of the cheek and the extraction of the remaining roots in the 3rdand 4thquadrant.Necrotic fasciitis is a rare, rapidly progressive infection of soft tissues, which, if untimely diagnosed and treated, may be life-threatening. The prognosis of treatment depends on the early recognition of the disease. It is treated with aggressive surgical debridement followed by antibiotic therapy.

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