Al Ani AH. et al., 2025: . Necrotising fasciitis following extracorporeal shock wave lithotripsy for ureteric stone: a rare and life-threatening complication.

Amer Hashim Al Ani, Omar Hosam Salama, Safa Abdulmajeed Al-Rawi, Fawziya Al Rubaye
BMJ Case Rep. 2025 Oct 29;18(10):e266497. doi: 10.1136/bcr-2025-266497

Abstract

This case report describes a rare and severe complication of extracorporeal shock wave lithotripsy (ESWL): necrotising fasciitis in a woman in her early 20s following treatment for a ureteric stone. The patient presented with escalating abdominal pain and signs of soft tissue infection, which advanced to involve the retroperitoneum and abdominal wall. Prompt imaging and diagnostic laparoscopy confirmed necrotising fasciitis. She underwent more than 10 surgical debridements, skin grafting and received prolonged antibiotic therapy. A multidisciplinary team approach was essential in achieving recovery. This case emphasises the need for high clinical suspicion for necrotising fasciitis post-ESWL, even in low-risk individuals. Key learning points include early recognition, aggressive surgical management and collaborative care to reduce morbidity and mortality associated with this life-threatening infection.

Comment Peter Alken

In appr. 30 % no source or comorbidity leading to Fournier Gangrene is found. So, it is questionable if the case described really is an ESWL complication. I have treated several patients with F.G, and I am surprised, why laparoscopy was done despite an unremarkable intra- and retroperitoneal CT. At least it is difficult to imagine that this step has positively contributed to the outcome.

Peter Alken