Necrotizing fasciitis (NF) of the breast is a rare occurrence that is routinely misdiagnosed as an abscess or cellulitis, resulting in treatment delays. A total mastectomy is required when delays occur. We present a 53-year-old female with breast NF managed with a partial mastectomy and local tissue rearrangement.
HighlightsFrequency of sliding hernias containing the bladder is only 5.6–12.5%.TAPP approach is preferred over a TEP approach in the laparoscopic repair of a sliding hernia.An open Lichenstein repair should be used in cases of recurrent hernias with severe complications, such as extensive adhesions or incarceration.Method of repair should be individualized based on careful analysis of clinical presentation and diagnostic findings.
Purpose: Necrotizing fasciitis (NF) is a life-threatening infection that involves spreading necrosis of the subcutaneous tissue and fascia that affects the extremities, abdominal wall, and perineum. Primary infection of the breast is a rare occurrence. Shah et al described the first case of primary breast NF and recommended radical “pseudotumor” excision and delayed skin closure months after resolution. Numerous other cases reported were successfully managed with different strategies. We aimed to summarize management options for primary breast NF through a systematic review of the literature. Methods: A systematic review of English literature was performed using PubMed. A total of 58 abstracts were reviewed. Data were abstracted from 25 cases that met inclusion criteria. Results: A total of 25 cases of primary NF of the breast without an inciting event were found within the literature. Common initial operations included total mastectomy (36.0%), excisional debridement (32.0%), and partial mastectomy (12.0%). A total or radical mastectomy was completed for definitive source control in 13 (52.0%) cases. A total of 18 cases underwent reconstruction. Split-thickness skin grafts (44.4%) and delayed primary closures (33.3%) were the most common methods of reconstruction. Conclusion: Majority of cases with primary breast NF are managed with a total mastectomy to gain source control. Reconstruction using split-thickness skin grafts was most common. Other options included delayed primary closure, full thickness skin grafts, local tissue rearrangement, and pedicle flap reconstruction. Reconstruction should be patient dependent, but the whole arsenal of the reconstructive ladder may be used.
Submucosal lipomas of the small bowel are rare, often asymptomatic, benign tumors. Large lesions may present with acute symptoms such as a bowel obstruction from an intussusception or acute hemorrhage. Acute findings such as these require operative intervention. In this case, we present a 53-year-old female with a complete small bowel obstruction secondary to a submucosal lipoma without signs of an intussusception.
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