Journal Article

Missed Wooden Perineum Foreign Body Leading to Extensive Necrotizing Soft Tissue Infection: A Case Report

Gyawali, Sushil, Pokhrel, Kailash Mani, Acharya, Abhaya, Khanal, Kapil, Chaulagain, Uttam, Khadka, Rabi, Gaurav, Bishal

2026

Overview

Penetrating perineal trauma is rare but carries a high risk due to contamination, hidden tracts, and proximity to major vessels and viscera. Retained organic foreign bodies, particularly wood, are often radiolucent and can perpetuate infection or erode into vascular structures. Necrotizing soft tissue infection (NSTI) is a devastating complication with significant mortality. A 53‐year‐old woman from rural Nepal presented 8 days after falling onto a tree branch, sustaining a perineal impalement. Her wound had been sutured primarily at a local center. She developed severe pain, swelling, foul discharge, and rectal bleeding. On exploration, extensive necrotic tissue and foul collections were found. MRI revealed a pelvic extension of infection but missed the wooden fragments. During subsequent staged debridements, two retained wooden pieces were discovered. Their removal precipitated massive pelvic hemorrhage requiring ligation of the right internal iliac artery. A loop colostomy was fashioned to prevent fecal contamination. After multiple surgeries and 53 days of inpatient care, she was discharged in stable condition. Key Clinical Message Penetrating perineal injuries carry a high risk of occult infection and vascular damage, especially when contaminated wounds are closed primarily. Wooden fragments may be missed on imaging and cause necrotizing soft‐tissue infection. Avoid primary closure in contaminated perineal wounds, and early referral when deeper injury or contamination is suspected.

• Publisher: Wiley
• Subject: impalement / necrotizing soft tissue infection / perineal injury / vascular complication / wooden foreign body