Necrotizing fasciitis of the abdominal wall secondary to a perforated sigmoid diverticulum in a Spiegel's hernia. A case report

It is uncommon that a complicated diverticular disease presents as an extraperitoneal manifestation, and it is also rare for diverticulitis to be the cause of a necrotizing fasciitis. Necrotizing fasciitis (NF) of the abdominal wall is not common and has a high mortality rate. We present a patient with NF of the abdominal wall secondary to a perforated colon diverticulum in a Spiegel's hernia without peritonitis or intraabdominal abscess. The absence of peritoneal manifestations delayed early diagnosis, which was evident through crepitation of the abdominal wall. Computed tomography (CT) revealed a severe inflammatory process characterized by the presence of gas in the abdominal wall. The patient underwent emergency surgery with debridement of all necrotic tissue, exploratory laparotomy, sigmoidectomy and derivative colostomy, but due to her advanced age and multiple organ failure, the outcome was fatal.