Retroperitoneal Necrotizing Soft Tissue Infection Caused by Pelvic Sepsis

Background: Necrotizing soft tissue infection of the retroperitoneum is an uncommon but serious problem that requires early diagnosis and aggressive treatment. Case Presentation: A 50-year-old Hispanic female presented to the emergency department with a four-day history of worsening abdominal pain. She was found to have peritonitis, lactic acidosis, leukocytosis, and imaging consistent with a necrotizing soft tissue infection of the retroperitoneum. She underwent multiple extensive surgical debridements. She also required hysterectomy, bilateral salpingo-oophorectomy, and sigmoid colectomy with end colostomy for source control in the pelvis. However, complete surgical debridement of the retroperitoneum was not possible because of proximity to major vessels. Despite maximal medical therapy, she died secondary to multi-organ failure. Conclusion: A high index of suspicion is warranted for patients presenting with signs and symptoms suggestive of a retroperitoneal necrotizing soft tissue infection. Early surgical debridement is the mainstay of treatment, but delays in presentation and challenges in diagnosis and complete surgical source control result in a high mortality for these infections.