Neorectal Perforation and Necrotizing Soft Tissue Infection of the Lower Limb Following Pelvic Reirradiation for...

Neorectal perforation is a rare but serious complication following treatment for rectal cancer, and may lead to catastrophic sequelae if diagnosis and management are delayed. We report the case of a 54-year-old woman with locally recurrent rectal cancer who developed neorectal perforation and necrotizing soft tissue infection of the lower limb following chemoradiotherapy. Initial symptoms were attributed to sciatic nerve inflammation, and surgical consultation was delayed. The patient subsequently developed septic shock and was found to have extraperitoneal perforation extending through the greater sciatic foramen, with extensive necrotizing fasciitis of the gluteal and thigh compartments. Management required urgent laparotomy with resection of the colonic J pouch, omentoplasty, feeding gastrostomy, and extraperitoneal end colostomy, followed by multiple surgical debridements. The patient experienced prolonged critical illness, including multiorgan failure and colonization of wounds with multidrug-resistant organisms. Successful recovery was achieved through aggressive multidisciplinary care, including novel use of negative pressure wound therapy with acetic acid instillation. This case highlights the need for caution when re-irradiating the neorectum in the presence of a neorectal ulcer, and the importance of early surgical involvement in complex post-treatment complications.