Necrotizing Fasciitis of the Thigh as Unusual Colonoscopic Polypectomy Complication: Review of the Literature with Case Presentation

Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms.

Colocolic intussusception in children: A case series and literature review

Background Colocolic intussusceptions is a rare subtype of intussusception mostly caused by juvenile polyps. The treatment of colocolic intussusception caused by other pathologic lead points remains poorly understood. Methods A systematic literature review between January 2000 and June 2021 was performed to characterize the comprehensive treatment of colocolic intussusception in children. This report also included 10 patients admitted to our center between 2010 and 2020 not previously reported in the literature. Results We identified 27 patients in 20 studies in addition to 10 patients from our center for a total of 37 patients (median age, 4.0 years; 54.1% male). The lead point was identified in 33 patients (33/37, 89.2%). The most common lead point was juvenile polyps (16/33, 48.5%). A therapeutic enema was performed in 12 patients with colocolic intussusception caused by juvenile polyps and was successful in 8 patients (8/12, 66.7%). Colonoscopic polypectomy was subsequently performed in 7 patients and was successful in 6 patients (6/7, 85.7%). The other patient had undergone laparoscopic exploration, and no abnormality was found. Subsequently, the patient underwent open surgery. The patients with colocolic intussusception caused by other pathologic lead points almost underwent surgical treatment (14/17, 82.4%), including 12 open surgeries and 2 laparoscopic surgeries. Conclusion A therapeutic enema followed by colonoscopic polypectomy is feasible to treat colocolic intussusception caused by juvenile polyps unless the patient has bowel perforation; however, open surgery is sometimes needed. For patients with colocolic intussusception caused by other pathologic lead points, open surgery may be preferable to laparoscopic surgery.