Multisystemic Infectious Compartment Syndrome Secondary to Cervicofacial Necrotizing Fasciitis with Thoracoabdominal Extension: A Case Report, Systematic Review, and Proposal of a Multidisciplinary Management Algorithm
DOI:
https://doi.org/10.70577/asce.v5i3.1030Keywords:
Necrotizing fasciitis; cervicofacial infection; Descending mediastinitis; compartment syndrome; thoracoabdominal extension; multidisciplinary management; surgical debridement.Abstract
Cervicofacial necrotizing fasciitis (CNF) is an aggressive infection with high mortality when it extends to the thorax. Additional abdominal involvement and the development of multisystemic compartment syndrome have not been characterized. This study describes the first documented case of multisystemic infectious compartment syndrome secondary to CNF with thoracoabdominal extension, synthesizes the evidence through a systematic review, and proposes a multidisciplinary management algorithm. A 58-year-old male, diabetic and smoker, with a 72-hour odontogenic infection that progressed to CNF with thoracic and abdominal extension. Computed tomography revealed gas and collections from the deep cervical space to the abdominal wall. Compartment pressures were: cervical 46 mmHg, mediastinal 38 mmHg, and abdominal 38 mmHg. Multidisciplinary surgical debridement (cervical, thoracic, and abdominal) with decompressive fasciotomies, targeted antibiotic therapy, and intensive support allowed patient survival, with hospital discharge on day 78. A search was conducted in PubMed, Scopus, and Web of Science up to May 2026 following PRISMA guidelines. From the identified records, cases of CNF with regional extension were selected. Thoracic extension occurred in approximately one-third of cases, with a survival rate of 60% compared to 100% without extension. Thoracoabdominal extension had not been previously reported, and no case documented multisystemic compartment syndrome. It is structured into four phases: (1) emergency triage (LRINEC score and CT); (2) operating room (extensive debridement and multidisciplinary fasciotomies); (3) intensive care unit (antibiotic therapy, hemodynamic and metabolic support); and (4) reconstructive phase (wound closure and grafts). It involves otolaryngology, thoracic surgery, general surgery, intensive care medicine, infectious diseases, and plastic surgery. Multisystemic infectious compartment syndrome due to CNF with thoracoabdominal extension is an exceptional and previously undescribed entity. The proposed multidisciplinary algorithm provides a structured framework that could improve outcomes in these highly complex cases.
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Copyright (c) 2026 Mónica Sofía Ramos Vargas , Daniel Eduardo Rodriguez Guevara , Kiara Shantal Rivera Pareja , Sophia Beatriz Cárdenas Verdezoto , Jamileth Yolanda Gaibor Litardo
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