Anterior Abdominal Wall Necrotizing Fasciitis Following Laparoscopic Sleeve Gastrectomy With Hiatal Hernia Repair: A
Hope Fozo1,2, Arani Thirunavukarasu1,2, Taiwo Ogundolie1,2
1Surgery, Suburban Surgery Center, Chicago, USA.
Abstract:
Necrotizing fasciitis (NF), commonly known as necrotizing soft tissue infection (NSTI), or flesh-eating disease is a rare but rapidly fatal aggressive bacterial infection of soft tissue and deep skin that results in the destruction of the underlying fascia. Symptoms include fever, tachycardia, hypotension, leukocytosis, pain, and large areas of red and swollen skin. Early diagnosis and aggressive management are compulsory for a better prognosis. In this case report, we present a 58-year-old obese woman who initially presented to the emergency department three weeks post-sleeve gastrectomy with hernia repair and was initially suspected of having a large, uncomplicated abdominal wall abscess. Several repeated drainages of the abdominal wall abscess and continued deterioration of the patient revealed foul-smelling, necrotic tissue and the subsequent diagnosis of NF. This case report highlights the importance of high clinical suspicion for NF and early, aggressive debridement and treatment to improve patient outcomes.
Insights
Necrotizing fasciitis (NF), a severe soft tissue infection, can rapidly progress. Early recognition and aggressive surgical debridement are crucial for improving patient outcomes in complex cases.
Area of Science:
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotizing fasciitis (NF), also known as necrotizing soft tissue infection (NSTI) or flesh-eating disease, is a rare, aggressive bacterial infection.
- It rapidly destroys soft tissue and fascia, leading to potentially fatal outcomes if not managed promptly.
Observation:
- A 58-year-old obese woman presented with symptoms initially suggestive of an abdominal wall abscess post-surgery.
- Despite repeated drainage, her condition deteriorated, revealing necrotic tissue consistent with NF.
Findings:
- The case highlights a delayed diagnosis of NF in a patient with a post-operative abdominal abscess.
- Aggressive surgical debridement and prompt treatment are essential for managing NF.
Implications:
- This case underscores the importance of maintaining a high clinical suspicion for NF, even in seemingly straightforward presentations.
- Early and aggressive intervention is critical for improving prognosis in patients with necrotizing fasciitis.
