Missed Wooden Perineum Foreign Body Leading to Extensive Necrotizing Soft Tissue Infection: A Case Report

Area of Science:

• Trauma Surgery
• Infectious Diseases
• Radiology

Background:

• Penetrating perineal trauma is uncommon but dangerous due to infection risk and proximity to vital structures.
• Retained organic foreign bodies, like wood, are often invisible on imaging and can cause persistent infection or vascular erosion.
• Necrotizing soft tissue infection (NSTI) is a life-threatening complication of such injuries.

Purpose of the Study:

• To highlight the diagnostic challenges and management complexities of penetrating perineal trauma with retained organic foreign bodies.
• To emphasize the potential for delayed diagnosis and severe complications, including NSTI and vascular injury.
• To underscore the importance of thorough surgical exploration and removal of all foreign material.

Main Methods:

• Case report of a 53-year-old woman with perineal impalement by a tree branch.
• Initial presentation with symptoms of severe infection and rectal bleeding 8 days post-injury.
• Diagnostic imaging (MRI) followed by staged surgical debridements.

Main Results:

• Initial MRI failed to identify retained wooden fragments, delaying definitive treatment.
• Surgical exploration revealed extensive necrotic tissue and infection.
• Removal of wooden fragments triggered massive pelvic hemorrhage, necessitating internal iliac artery ligation.
• A loop colostomy was performed to manage fecal contamination.
• The patient required multiple surgeries and 53 days of hospitalization.

Conclusions:

• Retained wooden foreign bodies in penetrating perineal trauma pose significant risks, including delayed diagnosis and severe complications.
• Thorough surgical exploration is paramount, as imaging may not detect radiolucent organic materials.
• Aggressive debridement, foreign body removal, and potentially vascular control and diversion are crucial for managing these complex injuries.