Giri et al. Journal of Medical Case Reports 2012, 6:53 http://www.jmedicalcasereports.com/content/6/1/53 cases of retroperitoneal necrotizing fasciitis have pre- sented with various clinical findings including fever and abdominal pain [7], features of peritonitis [8,9], flank pain [6], features mimicking appendicitis [10] as well as fever with abdominal pain, skin erythema and crepitus [5]. Our patient’s presentation of fever and features of peritonitis is hence not in isolation [8,9]. Similar cases of retroperitoneal NF presenting with features of peritonitis have been reported by Jayatunga et al. in 1993 and Sugimoto et al. in 2010 [8,9]. In the former, the patient was a 74-year-old diabetic woman with retroperitoneal necrotizing fasciitis limited to her pelvis [8]. In the latter, the patient was a 58-year-old hypertensive man with no obvious immunocompro- mised state who had developed extensive necrotizing fasciitis of the retroperitoneum. He also developed Four- nier’s gangrene post-operatively. A post-operative colo- noscopy revealed a colonic adenocarcinoma [9]. In the case reported by Jayatunga et al., microbiology revealed E. coli and Streptococcus faecalis sensitive to vancomycin and ceftazidime [8]. But in the case reported by Sugi- moto et al., Streptococcus anginosus was isolated [9]. In our case E. coli was isolated that was sensitive to cefo- perazone, however, we continued to cover for anaerobic bacteria as well. As in our patient’s case, both these cases had an unclear etiology and both patients survived following extensive debridement of the necrotic tissues and supportive care. Retroperitoneal necrotizing fasciitis is associated with a high mortality rate, with survival reported in very few cases [8-10]. Several factors could have helped contri- bute to the positive outcome for our patient. These include our patient’s age and absence of any comorbid- ities, urgent laparotomy being undertaken, and the extensive debridement of necrotizing tissues. Appropri- ate antibiotic treatment, good nursing care and proper metabolic and nutritional support would have contribu- ted to a complication-free post-operative period. Conclusions We report a case of retroperitoneal necrotizing fasciitis with an unclear etiology. Although severe and extensive inflammatory necrosis was found throughout the retro- peritoneum, our patient survived due to rapid and aggressive surgical intervention, broad-spectrum antibio- tics and good supportive care. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Page 3 of 3 Acknowledgements We thank Dr Bikal Ghimire (Tribhuvan University Teaching Hospital) for going through the manuscript and giving his expert comments. We also acknowledge the help of Mr Joseph Assad and Dr Chandra Giri for critically editing the final manuscript. Authors’ contributions SG wrote the manuscript. SG, BPK and PBSK gathered the clinical information, took consent from our patient and performed the literature review. PV contributed to the final manuscript and critically reviewed the intellectual content of the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 21 July 2011 Accepted: 10 February 2012 Published: 10 February 2012 References 1. Patino JF, Castro D: Necrotizing lesions of soft tissues: a review. World J Surg 1991, 15:235-239. 2. Tununguntla A, Raza R, Hudgins L: Diagnostic and therapeutic difficulties in retroperitoneal abscess. South Med J 2004, 97:110-119. 3. Takakura Y, Ikeda S, Yoshimitsu M, Hinoi T, Sumitani D, Takeda H: Retroperitoneal abscess complicated with necrotizing fasciitis of the thigh in a patient with sigmoid colon cancer. World J Surg Oncol 2009, 7:74. 4. Pryror JP, Piotrowski E, Seltzer CW: Early diagnosis of retroperitoneal necrotizing fasciitis. Crit Care Med 2001, 29:1071-1073. 5. Ammari JEEL, Ahssaini M, Fassi MJEL, Farih MH: Retroperitoneal necrotizing fasciitis due to chronic pyelonephritis. J Emerg Trauma Shock 2010, 3:419-420. 6. Secil M, Topacoglu H: Retroperitoneal necrotizing fasciitis secondary to colonic diverticulitis. J Emerg Med 2008, 34:95-97. 7. Woodburn KR, Ramsay G, Gillespie G, Miller DF: Retroperitoneal necrotizing fasciitis. Br J Surg 1992, 79:342-344. 8. Jayatunga AP, Caplan S, Paes TRF: Survival after retroperitoneal necrotizing fasciitis. Br J Surg 1993, 80:981. 9. Sugimoto M, Matsuura K, Takayama H, Kayo M, Le T: Extended retroperitoneal necrotizing fasciitis with genital involvement resembling Fournier’s gangrene. Surg Infect 2010, 11:463-467. 10. Devin B, McCarthy A, Mehran R, Auger CC: Necrotizing fasciitis of the retroperitoneum: an unusual presentation of group A Streptococcus infection. Can J Surg 1998, 41:156-160. doi:10.1186/1752-1947-6-53 Cite this article as: Giri et al.: Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report. Journal of Medical Case Reports 2012 6:53. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color ﬁgure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit