Abdominal Wall and limb necrotizing fasciitis: an extremely rare post -operative complication

Abstract

Introduction: Infectious affections are the most frequent post-operative complications, the rates have been reducing due to the administration of perioperative antibiotics and they are rarely serious. They are usually associated to pelvic collections, fistulas, urinary tract stenosis and, exceptionally, necrotizing fasciitis (FN) and pelvic organ necrosis [1].There is no well-codified therapeutic consensus,. An urgent care of pelvic necrosis requires surgical debridement of necrotic tissues with a broad-spectrum antibiotic. Case presentation: A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. She underwent chemo-radiation followed by a colpo-hysterectomy . Two months after surgery, the patient presented with recto-vaginal fistula associated with a pelvic collection. Abdominal CT scan revealed a recto-vaginal fistula fed by a 5cm pelvic collection originating from the uterine cavity. The patient was treated with antibiotics and then underwent a surgical evacuation of the collection and a bypass colostomy. The post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs, namely the bladder and the anterior wall of the rectum which extended to the anterior and medial left leg’s thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery, with necrosis of their vascular walls. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required, as well as ligature of the left external iliac vessels. The patient underwent post-surgical palliative treatment, and she died one month after surgery of multivisceral failure due to sepsis. Conclusion: Necrotizing fasciitis is a rare, but extremely serious condition, with a mortality rate of up to 30%. The prognosis can be improved with rapid management and appropriate medical and surgical treatment including large excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.