Sigmoid Diverticular Stricture With Large Bowel Obstruction, Hepatic Flexure Perforation, and Nonfatal Retroperitoneal Necrotizing Fasciitis Extending to the Neck

TL;DR

A rare case of severe complications from sigmoid diverticulosis, including bowel obstruction, perforation, and necrotizing fasciitis, was successfully treated with surgery and wound therapy.

Contribution

Presentation of a unique and rare case of necrotizing fasciitis extending to the neck from sigmoid diverticulosis with a successful outcome.

Findings

Sigmoid diverticular stricture led to large bowel obstruction and perforation.

Perforation caused retroperitoneal necrotizing fasciitis extending to the neck.

Emergency surgery and wound therapy resulted in patient survival.

Abstract

The most prevalent type of colonic diverticulum is sigmoid diverticulosis. Nevertheless, complications such as stricture formation, potentially leading to intestinal obstruction, are quite rare. Another uncommon consequence is perforation, which can, in exceptional cases, result in necrotizing fasciitis; however, spread to distant fascial planes is extremely unusual.

We present a remarkable case of a 61-year-old man who presented with sigmoid diverticular stricture causing large bowel obstruction and perforation. This resulted in extensive necrotizing fasciitis tracking from the retroperitoneum through the chest and into the cervical region. Despite the severity, the patient survived after undergoing an emergency laparotomy, total colectomy, serial debridements, and negative pressure wound therapy. This case highlights a unique complication of diverticular disease with an exceptionally favorable outcome.

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