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Necrotising fasciitis of the lower limb due to perforated inguinal hernia

T Georgiev-Hristov1, M Álvarez-Gallego, J B Juliá

  • 1Department of General and Abdominal Surgery, University Hospital La Paz, Madrid, Spain. tihomir.hristov@gmail.com

Hernia : the Journal of Hernias and Abdominal Wall Surgery
|June 15, 2010
PubMed

Insights

Necrotising fasciitis can arise from inguinal hernia perforation, even after reduction. Early diagnosis and surgical intervention are crucial for managing this severe complication, though outcomes can be poor.

Area of Science:

  • General Surgery
  • Infectious Diseases

Background:

  • Acute inguinal hernias, particularly incarceration and strangulation, are common, especially in the elderly.
  • Prompt surgical intervention is indicated when manual reduction fails or strangulation/perforation is suspected.

Observation:

  • A 77-year-old patient developed necrotising fasciitis of the lower limb following an extraperitoneal perforation of a sliding inguinal hernia.
  • Diagnosis was made 20 hours post-hernia reduction, prompted by physical findings (crepitation, cellulitis) and clinical decline, confirmed by CT scan.

Findings:

  • Urgent surgery included sigmoidectomy, debridement of necrotic thigh tissue, and fasciectomy.
  • Despite intensive care, the patient experienced a fatal outcome due to comorbidities, advanced age, and disease progression.

Implications:

  • This case highlights the critical importance of early recognition of strangulated hernia complications.
  • Even without acute abdominal signs, severe sequelae like necrotising fasciitis necessitate prompt diagnosis and management.

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