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Cervical Necrotizing Fasciitis and Shock in the Post-Operative Pediatric Patient
Paul Bryan Hankey1, Jason R Brown2,3
1College of Osteopathic Medicine, Kansas City University, Kansas City, MI, USA.
Insights
Cervical necrotizing fasciitis (CNF) is a rare but severe neck infection. This case highlights a pediatric patient developing acute shock post-surgery, emphasizing prompt diagnosis and intervention for survival.
Area of Science:
- Infectious Diseases
- Pediatric Surgery
- Critical Care Medicine
Background:
- Cervical necrotizing fasciitis (CNF) is a rare, aggressive infection affecting neck structures.
- It is typically polymicrobial and associated with comorbidities in adults.
- CNF complications usually involve tissue necrosis, with limited reports in pediatric post-operative patients.
Purpose of the Study:
- To report a unique case of pediatric CNF with acute shock following a Sistrunk procedure.
- To raise awareness of CNF as a potential post-operative complication in children.
- To underscore the urgency of identifying and managing CNF and associated shock.
Main Methods:
- Case report presentation of a pediatric patient.
- Review of clinical presentation, surgical history (Sistrunk procedure), and complications.
- Emphasis on diagnostic and therapeutic interventions.
Main Results:
- A pediatric patient developed CNF complicated by acute shock after a Sistrunk procedure for a thyroglossal duct cyst.
- This represents a novel presentation of CNF in the post-operative pediatric setting.
- Prompt medical and surgical management was critical for patient outcomes.
Conclusions:
- Pediatric surgeons must consider CNF and acute shock as potential post-operative complications, even after seemingly routine procedures.
- Awareness of diverse etiologies beyond odontogenic infections is crucial.
- Rapid identification and intervention are paramount for improving survival rates in pediatric CNF.
Abstract:
Cervical necrotizing fasciitis (CNF) is a rare infection that can quickly lead to devastating patient outcomes. Considering the vital importance of surrounding neck structures, rapid control of the infection is essential. Infection is most frequently polymicrobial and occurs in the adult patient in the context of certain medical comorbidities. Complications are typically limited to tissue destruction in the form of necrosis. There are no current reports describing CNF complicated by acute shock in the post-operative pediatric patient. Here, we present a pediatric case of CNF complicated by acute shock following Sistrunk procedure for removal of a supposed thyroglossal duct cyst. This case illustrates a potential post-operative complication that can be seen within the pediatric patient. Although most reported examples of CNF are polymicrobial and result from odontogenic infection, providers should be aware of other potential sources of disease. It is important for the pediatric surgeon to rapidly identify CNF and consequent shock, as prompt medical and surgical interventions are critical to offering the best chance of patient survival.
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