Necrotizing soft tissue infection (NSTI) is an aggressive and rapidly spreading soft tissue infection that could be associated with high mortality. Early diagnosis can be challenging and so a high index of suspicion is needed. Bedside ultrasonography (USG) and computed tomography (CT) scan could be employed to aid in diagnosis. The objective of this report is to describe the diagnostic process in a resource challenged setting and review the literature. We present an elderly patient with necrotizing fasciitis of the anterior abdominal wall as a complication of neglected strangulated Richter’s epigastric hernia that resulted in mortality.
Giant encapsulated haematoma of the anterior abdominal wall is an unusual complication of mesh incisional hernia repair. The commonest symptoms are swelling and pain. It can be diagnosed with ultrasonography and Computed Tomography (CT) scan. The objective of this case report is to illustrate the challenges of management of a complex pathology in a high-risk term pregnancy.
In this case report, a 28-year-old morbidly obese multiparous woman with two previous ventral wall hernia repairs and two previous caesarian sections, presented at term to the prenatal clinic with protruding anterior abdominal mass. Initial preoperative diagnosis aided by ultrasonography was a herniated term gestation through an incisional hernia. Intraoperatively, the surgical team was faced with the challenge of managing a longstanding giant organized haematoma of the anterior abdominal wall and the anticipation and prevention of obstetric complications associated with two previous caesarian sections and a big baby. This report illustrates that good clinical assessment combined with sonographic assessment of complex cases by an experienced radiologist is crucial to avoid missed diagnosis. A multidisciplinary team management was essential for a successful outcome.
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