open access
Highlights
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- Necrotizing fasciitis has not previously been reported in association with placement of intrapertioneal port at the time of cytoreductive surgery
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- Consensus is lacking regarding the placement of intraperitoneal ports at the time of bowel surgery
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- Delayed placement of intraperiteonal ports may be considered in patients undergoing bowel resection
Introduction
Intraperitoneal
(IP) chemotherapy has a proven survival advantage in patients with
optimally cytoreduced advanced epithelial ovarian cancer [1]. Placement
of IP catheters can be performed at the time of optimal cytoreductive
surgery [2-3]. Reported here is the case of a woman with stage IIIC
serous adenocarcinoma of primary peritoneal origin who underwent optimal
cytoreductive surgery and IP catheter placement, who was readmitted on
post-operative day 10 with necrotizing fasciitis of her anterior
abdominal wall originating at the IP catheter site.
Case
A
63-year-old nulligravid female with a past medical history significant
for moderately controlled type II diabetes (glycosylated hemoglobin
7.5%), hypertension, hyperlipidemia, and morbid obesity (BMI 44 kg/m2)
presented to her primary care physician with complaints of two weeks of
lower abdominal pain, bloating, early satiety, and nausea. She was
treated with antibiotics for presumed diverticulitis for 2 weeks without
resolution of symptoms. A CT scan of the abdomen and pelvis revealed
inflammatory changes in the pelvis surrounding the bilateral adnexa and
sigmoid colon with multiple colonic diverticula present suggestive of
uncomplicated diverticulitis, omental nodularity, and soft tissue
prominence in the left adnexa. Pelvic ultrasound showed a 5 cm calcified
fibroid with submucosal extension, and the ovaries could not be
visualized. A serum CA125 level was elevated to 907 U/mL. She was
referred to the Gynecologic Oncology clinic for further evaluation and
scheduled for surgery. The patient underwent a diagnostic laparoscopy,
which revealed omental caking, moderate straw-colored ascites, and bowel
adhesions to the anterior abdominal wall. Due to findings concerning
for malignancy, the procedure was converted to laparotomy and optimal
cytoreduction to < 1 cm residual disease was performed, including
total abdominal hysterectomy, bilateral salpingo-oophorectomy,
infragastric omentectomy, appendectomy, resection of proximal descending
colon with side-to-side re-anastomosis. IP port was placed at the time
of surgery. Surgical pathology showed a stage IIIC high-grade serous
adenocarcinoma of primary peritoneal origin.
The
immediate post-operative course was uncomplicated and she was
discharged home on post-operative day 5. On post-operative day 10, the
patient presented to clinic with complaints of increased left sided
abdominal pain that she described as a constant, pulling sensation
centralized around the IP port site.........
