Background: Necrotizing fasciitis is a rare but life-threatening soft tissue infection characterized by rapid progression, sepsis, and high mortality. Early recognition of the disease and timely surgical treatment are essential for improving patient outcomes.
Case Report: We present the case of a 54-year-old woman with type 2 diabetes mellitus, grade IV obesity, and a sacral pressure ulcer. The patient was admitted to the emergency department with pain in the left side of the abdomen and pelvic region. Contrast-enhanced computed tomography revealed an inflammatory process with gas collections in the left ischiorectal fossa and a fistulous tract communicating with the sacral pressure ulcer. No evidence of involvement of the anterior abdominal wall or abdominal musculature was identified at the initial examination.
Despite medical recommendations, the patient left the hospital against medical advice. Several days later, she was readmitted in severe septic condition. Follow-up CT demonstrated rapid progression of the infection with extension to the anterior abdominal wall, involvement of the left rectus abdominis muscle, and a pathological fracture of the coccyx. Emergency surgical treatment, including debridement, drainage, and the formation of a protective colostomy, was performed. Despite intensive treatment, the patient developed progressive clinical deterioration and eventually died.
Conclusion: This case illustrates how a seemingly localized ischiorectal phlegmon can rapidly progress to necrotizing fasciitis and severe sepsis. Computed tomography plays a crucial role both in the initial assessment and in monitoring the extent of disease progression. Early diagnosis and prompt surgical intervention remain key factors in reducing complications and improving patient survival.
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