{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:44:46Z","timestamp":1782992686810,"version":"3.54.5"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"DOI":"10.13039\/501100003483","name":"Hebrew University of Jerusalem","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003483","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Wien Med Wochenschr"],"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The incidence of necrotizing soft tissue infections is increasing, and associated mortality remains high. It is important to make an early diagnosis, but diverse atypical presentations occur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient<\/jats:title>\n                    <jats:p>An older adult patient was admitted with sepsis syndrome without localizing clues. Necrotizing fasciitis of the right thigh and gluteus developed, and CT revealed an adjacent inflammatory cecum mass which was diagnosed during surgery as perforated adenocarcinoma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A\u00a0review of the literature revealed that this rare type of necrotizing soft tissue infection is characteristic of rectosigmoid or ascending colon perforation, often being its presenting feature and the first clue to an occult underlying disease. Myriad etiologies of perforations have been reported to be associated with thigh, flank, or abdominal wall necrotizing fasciitis and peritonitis, but this syndrome remains poorly recognized. Better awareness will lead to more timely diagnosis and aggressive multifaceted treatment, which are essential for patient survival.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10354-026-01171-6","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:07:38Z","timestamp":1782990458000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Necrotizing fasciitis of the thigh\u2014a\u00a0devastating sign of intestinal perforation","Nekrotisierende Fasziitis des Oberschenkels \u2013 lebensgef\u00e4hrliches Symptom einer Darmperforation"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1413-8858","authenticated-orcid":false,"given":"Ami","family":"Schattner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yair","family":"Glick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"1171_CR1","doi-asserted-by":"publisher","first-page":"2253","DOI":"10.1056\/NEJMra1600673","volume":"377","author":"DL Stevens","year":"2017","unstructured":"Stevens\u00a0DL, Bryant\u00a0AE. Necrotizing soft tissue infections. N Engl J Med. 2017;377:2253\u201365.","journal-title":"N Engl J Med"},{"key":"1171_CR2","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1097\/SLA.0000000000002774","volume":"269","author":"SM Fernando","year":"2019","unstructured":"Fernando\u00a0SM, Tran\u00a0A, Chang\u00a0W, et\u00a0al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg. 2019;269:58\u201365.","journal-title":"Ann Surg"},{"key":"1171_CR3","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1089\/sur.2018.022","volume":"19","author":"D Kumar","year":"2018","unstructured":"Kumar\u00a0D, Cortes-Penfield\u00a0NW, El-Hadad\u00a0H, et\u00a0al. Bowel perforation resulting in necrotizing soft-tissue infection of the abdomen, flank, and lower extremities. Surg Infect. 2018;19:467\u201372.","journal-title":"Surg Infect"},{"key":"1171_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1947-8-80","volume":"8","author":"SJ Timbrell","year":"2014","unstructured":"Timbrell\u00a0SJ, Straiton\u00a0D, Breaks\u00a0E, et\u00a0al. Necrotizing soft tissue infection of the lower limb due to a perforated caecal carcinoma: a case report. J\u00a0Med Case Rep. 2014;8:80.","journal-title":"J Med Case Rep"},{"key":"1171_CR5","doi-asserted-by":"publisher","first-page":"2580","DOI":"10.1007\/s00268-020-05559-2","volume":"44","author":"DMS Bodansky","year":"2020","unstructured":"Bodansky\u00a0DMS, Bengaj\u00a0I, Evison\u00a0F, et\u00a0al. A 16-year longitudinal cohort study of incidence and bacteriology of necrotizing fasciitis in England. World J Surg. 2020;44:2580\u201391.","journal-title":"World J Surg"},{"key":"1171_CR6","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1001\/jamasurg.2024.3365","volume":"159","author":"J McDermott","year":"2024","unstructured":"McDermott\u00a0J, Kao\u00a0LS, Keeley\u00a0JA, et\u00a0al. Necrotizing soft tissue infections. A review. JAMA Surg. 2024;159:1308\u201315.","journal-title":"JAMA Surg"},{"key":"1171_CR7","doi-asserted-by":"publisher","first-page":"e10","DOI":"10.1093\/cid\/ciu296","volume":"59","author":"DL Stevens","year":"2014","unstructured":"Stevens\u00a0DL, Bisno\u00a0AL, Chambers\u00a0EF, et\u00a0al. Practice guidelines for the diagnosis and management of necrotizing soft tissue infections: 2014 update by the Infectious Diseases Societu of America. Clin Infect Dis. 2014;59:e10\u2013e52.","journal-title":"Clin Infect Dis"},{"key":"1171_CR8","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1007\/DCR.0b013e318197e351","volume":"52","author":"N Cheynel","year":"2009","unstructured":"Cheynel\u00a0N, Cortet\u00a0M, Lepage\u00a0C, et\u00a0al. Incidence, patterns of failure, and prognosis of perforated colorectal cancers in a well-defined population. Dis Colon Rectum. 2009;52:406\u201311.","journal-title":"Dis Colon Rectum"},{"issue":"4","key":"1171_CR9","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofad117","volume":"10","author":"PCK Tam","year":"2023","unstructured":"Tam\u00a0PCK, Kennedy\u00a0B, Ashokan\u00a0A. Necrotizing soft tissue infections in South Australia: a 15-year review. Open Forum Infect Dis. 2023;10(4)ofad117.","journal-title":"Open Forum Infect Dis"},{"key":"1171_CR10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-066117","volume":"13","author":"M Hedetoft","year":"2023","unstructured":"Hedetoft\u00a0M, Madsen\u00a0MB, Hyldegaard\u00a0O. Hyperbaric oxygen treatment in the management of necrotising soft tissue infections: results from Danish nationwide registry study. 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