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Zagardo V, Pergolizzi S, Ferini G. Extensive necrosis of the tongue as a very early adverse event of head and neck radiotherapy. Oral Oncol 2024; 155:106880. [PMID: 38850767 DOI: 10.1016/j.oraloncology.2024.106880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Valentina Zagardo
- Radiation Oncology Unit, REM Radioterapia, 95100 Viagrande, CT, Italy
| | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental and Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit, REM Radioterapia, 95100 Viagrande, CT, Italy; School of Medicine, University Kore of Enna, 94100 Enna, Italy.
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Wadhwani N, Bhola N, Yelne P. Necrotizing Fasciitis Co-existing With Oral Squamous Cell Carcinoma: A Case Report of a Diagnostic Dilemma. Cureus 2024; 16:e62947. [PMID: 39050346 PMCID: PMC11265955 DOI: 10.7759/cureus.62947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024] Open
Abstract
Necrotizing fasciitis is an uncommon yet highly dangerous bacterial infection characterized by rapid spread along the fascial planes and subcutaneous tissue, leading to extensive tissue necrosis and often resulting in death. The swift progression of necrosis can induce systemic sepsis, toxic shock syndrome, and multi-organ failure. While necrotizing fasciitis of the neck is rare, it typically originates from dental or pharyngeal sources. Successful treatment hinges on early diagnosis, appropriate antibiotic therapy, and surgical intervention for tissue debridement. This article presents the case of a 40-year-old individual with necrotizing fasciitis of the neck. We herein review the clinical features, pathogenesis, and treatment approach for the case. Rapid recovery necessitated comprehensive medical treatment targeting the underlying cause with aggressive supportive measures. Surgical intervention involved thorough debridement to remove necrotic tissue, irrigation with antiseptic solutions, and early application of topical antimicrobials.
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Affiliation(s)
- Nikhar Wadhwani
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitin Bhola
- Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Yelne
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Malik A, Chakrabarty S, Nair S, Nair D, Chaturvedi P. Necrotizing fasciitis in patients with head and neck cancer. Am J Infect Control 2015; 43:404-5. [PMID: 25721060 DOI: 10.1016/j.ajic.2015.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 12/20/2022]
Abstract
Necrotizing fasciitis is a severe polybacterial infection characterized by necrosis of the fascia and adjacent soft tissues with rapid expansion of the infection along the fascial planes. It is a rare and potentially fatal entity in the head and neck region. We present 2 patients with head and neck cancers who developed necrotizing fasciitis during the postoperative period.
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Kawai K, Sunami E, Nishikawa T, Tanaka J, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Kazama S, Ishihara S, Yamaguchi H, Kitayama J, Watanabe T. Delayed abdominal wall abscess after abdomino-perineal resection simulating local recurrence of rectal cancer. SPRINGERPLUS 2014; 3:681. [PMID: 25520908 PMCID: PMC4247831 DOI: 10.1186/2193-1801-3-681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/13/2014] [Indexed: 12/13/2022]
Abstract
Introduction We report a rare case of delayed abdominal wall abscess after abdominoperineal resection (APR) for rectal cancer. Case description A 63-year-old woman was diagnosed with rectal cancer and received chemo-radiotherapy, followed by APR. One year after surgery, the patient complained of pain and skin redness in the lower abdomen. A low-density mass lesion with 5.9-cm diameter was found in the lower abdominal wall by computed tomography, which showed high uptake on positron-emission tomography. These findings suggested the possibilities of either delayed abscess formation or abdominal wall recurrence of rectal cancer with central necrosis. Percutaneous drainage was performed. The content was a purulent exudate, without neoplastic cells in the cytology. The lesion quickly disappeared after the drainage, and no recurrence of the tumor was observed for more than 2 years. Discussion and evaluation In this case, the un-absorbable yarn, such as silk, has not been used during the operation, no foreign body was retained in the abdominal wall, and there was no associated inflammatory bowel disease. Use of neoadjuvant chemoradiotherapy was the only possible cause of delayed abscess formation in this case. Conclusion In case local recurrence is suspected by imaging modalities in the postoperative of colorectal cancer, especially those with precedent chemoradiotherapy or radiotherapy, although rare, the possibility of a delayed abscess formation should also be considered.
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Affiliation(s)
- Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Eiji Sunami
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Junichiro Tanaka
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Tomomichi Kiyomatsu
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Keisuke Hata
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Shinsuke Kazama
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Hironori Yamaguchi
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Joji Kitayama
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, Faculty of Medicine, the University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
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Surkin MI, Schwartz SA, Markiewicz DA. Late-onset complications after chemoradiation for head and neck carcinomas. EAR, NOSE & THROAT JOURNAL 2014; 92:E18. [PMID: 23975497 DOI: 10.1177/014556131309200822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Acute complications from chemoradiation for head and neck cancers are relatively common. These can be minor or severe and can have a significant impact on the patient's quality of life. The incidence of late-onset (>5 years after cancer cure) complications is unknown, but the effect on quality of life is just as severe as with acute problems. What makes matters worse is that many of these patients lived years without dysphagia or other issues and were able to resume a normal lifestyle before developing complications. We present 4 cases involving patients with late-onset complications and discuss the need to remain vigilant in follow-up and caring for patients with head and neck cancer.
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Affiliation(s)
- Marc I Surkin
- Department of Otolaryngology, Drexel University College of Medicine, 301 West Chester Pike, Havertown, PA 19083, USA.
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Perrakis N, Athanassiou E, Vamvakopoulou D, Kyriazi M, Kappos H, Vamvakopoulos NC, Nomikos I. Practical approaches to effective management of intestinal radiation injury: Benefit of resectional surgery. World J Gastroenterol 2011; 17:4013-6. [PMID: 22046090 PMCID: PMC3199560 DOI: 10.3748/wjg.v17.i35.4013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 12/26/2010] [Accepted: 01/02/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the outcome of patients undergoing surgical resection of the bowel for sustained radiation-induced damage intractable to conservative management.
METHODS: During a 7-year period we operated on 17 cases (5 male, 12 female) admitted to our surgical department with intestinal radiation injury (IRI). They were originally treated for a pelvic malignancy by surgical resection followed by postoperative radiotherapy. During follow-up, they developed radiation enteritis requiring surgical treatment due to failure of conservative management.
RESULTS: IRI was located in the terminal ileum in 12 patients, in the rectum in 2 patients, in the descending colon in 2 patients, and in the cecum in one patient. All patients had resection of the affected region(s). There were no postoperative deaths, while 3 cases presented with postoperative complications (17.7%). All patients remained free of symptoms without evidence of recurrence of IRI for a median follow-up period of 42 mo (range, 6-96 mo).
CONCLUSION: We report a favorable outcome without IRI recurrence of 17 patients treated by resection of the diseased bowel segment.
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Postirradiation Klebsiella pneumoniae-associated necrotizing fasciitis in the western hemisphere: a rare but life-threatening clinical entity. Am J Med Sci 2009; 338:217-24. [PMID: 19581796 DOI: 10.1097/maj.0b013e3181a393a4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Necrotizing fasciitis (NF) caused by Klebsiella spp. is a unique entity, particularly, in Asia, where virulent strains of Klebsiella predominate. It is now clear that Klebsiella spp. are capable of causing NF either isolated or in the context of disseminated disease. We present a unique case of NF caused by Klebsiella pneumoniae in the Western hemisphere after radiotherapy in a hospitalized patient with significant comorbidities. Physicians should be aware of nosocomially acquired K. pneumoniae fasciitis after radiotherapy in the setting of chronic comorbidities, such as diabetes and malignancy. Early diagnosis, surgical intervention, and appropriate empirical antibiotics are essential for a favorable outcome in such rare but life-threatening cases of NF.
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Allender MC, McCain SL, Ramsay EC, Schumacher J, Ilha MRS. Cervical necrotizing fasciitis and myositis in a western lowland gorilla (Gorilla gorilla gorilla). J Med Primatol 2009; 38:156-9. [PMID: 19239573 DOI: 10.1111/j.1600-0684.2009.00337.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 39-yr-old wild-caught, female western lowland gorilla (Gorilla gorilla gorilla) died during an immobilization to assess swelling and apparent pain of the cervical region. Necropsy revealed a fistulous tract containing plant material in the oropharynx, above the soft palate, communicating with a left-sided cervical necrotizing fasciitis and myositis. Alpha-hemolytic Streptococcus and Prevotella sp. were isolated from the cervical lesion. This is a report of cervical necrotizing fasciitis in a western lowland gorilla.
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Affiliation(s)
- M C Allender
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA.
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