Giri et al. Journal of Medical Case Reports 2012, 6:53 http://www.jmedicalcasereports.com/content/6/1/53 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report Smith Giri*, Bishnu P Kandel, Prasan BS Kansakar and Pradeep Vaidya Abstract Introduction: Retroperitoneal necrotizing fasciitis is a rare, fulminant, and potentially lethal complication of intra- abdominal suppuration. A retroperitoneal origin is very rare and very few cases have been reported in the literature. To the best of our knowledge, this case is only the fourth case reported of successful management following retroperitoneal necrotizing fasciitis. Case presentation: A 33-year-old Tamang man presented to our facility with a history of five days of fever and vomiting and eight days of severe left loin pain. On examination, he had features of peritonism. A laparotomy was performed, revealing extensive necrotizing fasciitis of the retroperitoneum extending to the anterior abdominal wall. Our patient survived following extensive debridement of the necrotic tissues and supportive care. Conclusions: Retroperitoneal necrotizing fasciitis can rarely present with features of peritonism, and hence should be included as a possible differential diagnosis for anyone presenting with peritonism. Although a fatal condition, early intervention and aggressive management can save the life of a patient. Background Necrotizing fasciitis (NF) is a relatively rare but rapidly spreading necrotizing infection of the subcutaneous tis- sues. It is caused by rapid proliferation of microorgan- isms. Originally described by Wilson in 1952, studies have reported varying mortality rates ranging from 20% to 40% [1]. Patients with compromised immune systems, such as those with diabetes mellitus, chronic renal fail- ure, drug misuse, advanced age and other immunocom- promised states, are at an increased risk of developing NF [1]. The diagnosis of NF is purely clinical, with laboratory parameters suggesting, but not confirming, the diagnosis [2]. It can occur in any region of the body but most commonly manifests in the extremities, abdominal wall and perineum [3]. Retroperitoneal necrotizing fasciitis is extremely rare [4], with very few cases reported in the literature. Here, we present the case of a 33-year-old man with retroperitoneal necrotizing fasciitis. * Correspondence: smithgiri963@gmail.com Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal Case presentation A 33-year-old Tamang man presented to the Emergency Department of Tribhuvan University Teaching Hospital with the chief complaints of fever, multiple episodes of non-bilious vomiting over the last eight days and severe left loin pain for the last five days. He reported trauma to his back about three weeks ago associated with back- ache, subsiding in a few days. There was no other signif- icant history. Our patient chewed tobacco regularly and occasionally consumed alcohol. On examination, he had a pulse rate of 120 beats/min- ute and temperature of 38.3°C. Abdominal examination revealed generalized rigidity and guarding along with other features of peritonism. His renal angles were non- tender. There were no other findings of significance. Investigations revealed a raised white blood cell count (WBC; 24,900 cells/mm3). Blood sugar level, urea, crea- tinine and urine microscopic examination and culture results were all normal. Serum amylase and lipase levels, along with the results of a chest X-ray were normal. An abdominal ultrasound scan revealed a minimal amount of free fluid in the pelvis. Aspiration revealed a purulent exudative fluid (total count of 25 000 cells per mm3). © 2012 Giri et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.