Complicated Sigmoid Diverticulitis Presenting as Severe Necrotizing Soft Tissue Infection
Bibliographic record
Abstract
Background: Necrotizing soft tissue infection is a rare and aggressive medical and surgical emergency characterized by intense and severe tissue destruction, rapid onset systemic toxicity, and high mortality. Diverticulitis is a common complication of diverticular disease. However, its presentation as necrotizing soft tissue infection is rare. It is always important to identify the precipitating cause of necrotizing soft tissue infection to assist in appropriate treatment and risk stratification. Case Presentation: The patient was an 84-year-old female with a history of hypertension and chronic obstructive pulmonary disease with long-term steroid dependency. She presented to the emergency department with abdominal tenderness, left abdominal wall cellulitis, crepitus, and septic shock. Abdominal and pelvic computed tomography findings showed intra-abdominal abscess secondary to perforated sigmoid diverticulitis with abdominal wall abscess and necrotizing soft tissue infection of abdominal wall, chest wall, groin, and back. After intravenous fluid resuscitation and antibiotics, the patient underwent urgent laparotomy. She was found to have a large abdominal wall abscess, perforated sigmoid diverticulitis, and extensive necrosis of the torso extending from the groin to chest wall including the back. Conclusion: Abdominal wall necrotizing soft tissue infection is an uncommon complication of perforated diverticulitis. In an elderly immunocompromised patient with septic shock, perforated diverticulitis, and necrotizing soft tissue infection, the prognosis is poor.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".