A 48-year-old male patient with severe sepsis and distended painful and tender abdomen with features of intestinal obstruction with failing urine output and blood pressure and pulse rate of 170 / min and extremely high breath rate and 104 temperature was presented before renowned Gastrointestinal Surgeon Dr. Suddhasattwa Sen.
The patient was accordingly resuscitated, monitored, and investigated with blood and CT scan abdomen and other tests which revealed that the patient has developed an extraordinarily rarest of a rare condition called Idiopathic retroperitoneal necrotizing fasciitis. Retroperitoneal necrotizing fasciitis itself is extremely rare which has colon or pancreas or appendix or kidney as a source of infection. But rarest of rare ones don’t have an exact reason for such severe lethal life-threatening conditions.
It is so rare that hardly handful cases are so far reported in the world till date and so rare that actual prevalence maybe in millions or billions as no official figure exists due to less number of cases across the world.
Speaking to News Sense, Dr Suddhasattwa Sen said, “We did immediate emergency surgery which was extremely challenging due to technical problems of PPE and severe difficulty for surgical team due to extreme heat and suffocating effect of 3 layers of surgical gear and also because patient was moribund and obese with dilated intestines and very little space inside abdomen”.
He further adds, “there was extensive necrosis and gangrene of fat, muscles, fascia in both sides of retroperitoneal area as well as entire parities of patient with pus and air pockets. Extensive mobilization to open up entire root of mesentery. Bilateral Extensive periteinectomy with drainage of necrotic tissue with debridement of necrotic fascia muscles, fat. Preserve all structures, as there are too many. Open up all layers individually and drain wherever there is pus or air fluid in parieties. Omentectomy for necrotic areas of omentum. Luckily bowels didn’t need resection. Appendectomy was needed as it was unhealthy inflamed and tip had impending perforation. Lavage and multiple bilateral 32 AdK and ryles tube for continuous flushing to be planned. The openings of layers are also quite tricky as they are no more exactly anatomical due to multilayer necrosis with patches of non-necrotic inflamed fused areas”.
After over three hours of strenuous hard work inside operation theatre, the surgery was successful and a new history is created. After 8 days the patient was discharged from the hospital. He is doing fine with vitals and urine, abd pressure saturations are doing well.
Dr. Sen says, “This is probably the 1st case in the world, where the patient survived in just 1 complete surgery and no organ support required. So far, 14 such cases have been reported, out of which 11 are dead and 3 survived. All the 3 patients were younger and needed 6 to 8 major surgery and weeks of hospital stay”.
