A case report of necrotizing fasciitis of the abdominal wall: A rare, life-threatening complication of a common disease process

Romanoff, Anya; Freed, Jeffrey S.; Heimann, Tomas M.

doi:10.1016/j.ijscr.2016.09.005

Cited by 14 publications

(16 citation statements)

References 3 publications

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“…The literature consensus for management of all NSTI is centred on resuscitation of the patient to minimise end-organ damage, broad-spectrum antibiotics, and immediate, radical resection of affected tissue [1][2][3][4][5]8,9,[11][12][13][14][15][16][17][18]. Time to surgery is often described as the most important determinant for reducing mortality and morbidity [5,[12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…Necrotizing soft tissue infection (NSTI), also known as necrotizing fasciitis, is an uncommon disease entity that is characterised by rapidly progressing skin and soft tissue destruction [1,2] with a high mortality rate. Early radical surgical resection of infected tissue coupled with broad-spectrum antibiotic coverage and systemic support for sepsis are imperative to improve survival [1][2][3]. It is proposed that NSTIs [4][5][6][7] exist on a continuum and range from subacute to hyperacute fulminant infections.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Peters¹,

Iacobelli²,

Ryan³

2020

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Peters¹,

Iacobelli²,

Ryan³

2020

Cureus

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“…Here we reported the first case of a perforated appendix complicated with necrotizing fasciitis in a patient with AOSD. Perforated appendix complicated with necrotizing fasciitis of the abdominal wall or thigh is rare [ 3 , 4 ] and has a high mortality rate of 30%. Steroid is a standard treatment for AOSD but can mask the toxic signs of appendicitis, and we should pay more attention to differential diagnosis in these complicated and easily missed diagnosis cases at ER.…”

Section: Discussionmentioning

confidence: 99%

“…Perforated appendix complicated with necrotizing fasciitis of the abdominal wall or thigh is rare [ 3 , 4 ] and has a high mortality rate of 30%. Conservative treatment with antibiotics for perforated appendix is safe but has a failure rate of about 7%, [ 5 ] higher in immunocompromised patients such as steroid using for autoimmune disease.…”

Section: Introductionmentioning

confidence: 99%

Acute appendicitis complicated with necrotizing fasciitis in a patient with adult-onset Still's disease

Huang

Chiu

Ho³

et al. 2018

Medicine

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Rationale:Adult-onset Still disease (AOSD) is a rare systemic inflammatory disease of unknown etiology characterized by evanescent salmon-pink rash, spiking fever, arthralgia/ arthritis, and lymphadenopathy. AOSD sometimes was fatal when it is complicated by macrophage activation syndrome (MAS) or hemophagocytic lymphohistiocytosis (HLH). Nonetheless, the literature provides no recommendations for treatment of AOSD patients with severe sepsis.Patient concerns:A previously healthy 65-year-old man with history of AOSD was referred to our hospital for persistent right lower quadrant abdominal pain for 2 days. One week later, an abdominal wall abscess and hematoma developed by extravasation from the inferior epigastric vessels, complicated by necrotizing fasciitis of the right thigh and groin region. To our best knowledge, this case was the first reported case of a perforated appendix complicated with necrotizing fasciitis in a patient with AOSD.Diagnoses:The patient was diagnosed as acute appendicitis complicated with necrotizing fasciitis and abdominal wall abscess.Interventions:This case received intravenous tigecycline injection and daily 10 mg prednisolone initially, and shifted to daily intravenous hydrocortisone 200 mg for suspected MAS or HLH. This patient underwent surgical intervention and debridement for necrotizing fasciitis.Outcomes:The patient's symptoms progressed worse rapidly. He died from cytomegalovirus viremia and bacterial necrotizing fasciitis complicated by septic shock.Lessons:(1) The steroid dose was difficult to titrate when AOSD complicated by sepsis. The differential diagnosis from MAS/HLH with bacterial/viral infection related severe sepsis was difficult but critical for decision making from clinicians and rheumatologists. (2) The conservative treatment with antibiotics for perforated appendix is safe but has a higher failure rate in immunocomprised patients such as systemic lupus erythematosus and AOSD. Early surgical intervention might contribute to better outcome. (3) The abdominal wall abscess can be spread from intra-abdominal lesion through the inferior epigastric vessels which were as weak points of abdominal wall. Imaging examinations contribute to acute diagnosis and help surgeons perform surgical interventions to prevent morbidity and mortality.

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“…A case study was reported on a 71year old patient who presented with acute appendicitis but eventually developed a perforated appendicitis resulting in NF of the abdominal flap [10]. It was investigated with CT scans and subsequent emergency laparotomy performed.…”

Section: Similar Case Studiesmentioning

confidence: 99%

Cascade of Surgical Complications: A Case of Necrotizing Fasciitis

2019

AIDT

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A 60 year old female presented with abdominal distension and non-specific abdominal pain and describes herself to have a ‘lazy bowel’, with a complicated surgery history. Patient subsequently underwent an emergency laparotomy for multiple small bowel perforations, requiring small bowel resection. The patient developed necrotizing fasciitis (NF) due to an increased use of inotropes during surgery which causes excessive vasoconstriction, and she had a major portion of the abdominal flab removed. This followed by a 33 day ITU admission (level 3) due to septic shock and poor pulmonary compliance. During the ITU stay, the patient was taken back into theatre 14 times for vac dressing changes to reduce the pressure from 150 mmHg down to 25 mmHg. Back in the surgery ward, the patient developed a fistula due to the vac dressing eroding the small bowel, leading to a proximal jejunostomy in situ which effectively worked as a high output stoma. The patient later suffered from re-feeding syndrome as the feed was primarily through the jejunostomy. Eventually absorbable mesh was added behind the vac dressing to protect the soft tissue underneath and the final stage was referral to plastic surgeons that would a joint reconstruction of the abdominal wall with the general surgeons at St Marks (tertiary centre for intestinal feeding and the combined reconstruction).

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A case report of necrotizing fasciitis of the abdominal wall: A rare, life-threatening complication of a common disease process

Cited by 14 publications

References 3 publications

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Recurrent Necrotizing Fasciitis: A Case Report of Fulminant and Sub-Acute Necrotizing Fasciitis in a Diabetic Patient

Acute appendicitis complicated with necrotizing fasciitis in a patient with adult-onset Still's disease

Cascade of Surgical Complications: A Case of Necrotizing Fasciitis

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