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Cellulitis and necrotizing fasciitis of the abdominal wall in pediatric patients
Insights
Pediatric abdominal wall infections range from cellulitis to necrotizing fasciitis. Early recognition of severe signs like dusky skin is crucial for timely surgical intervention and preventing fatalities.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Neonatology
Background:
- Soft tissue infections of the abdominal wall in children are uncommon but can be severe.
- Classifications include cellulitis, necrotizing fasciitis, and myositis/myonecrosis, reflecting increasing depth and severity.
Purpose of the Study:
- To classify pediatric abdominal wall infections.
- To identify clinical features and associations.
- To highlight diagnostic signs and treatment implications.
Main Methods:
- Retrospective review of 14 pediatric cases.
- Classification based on infection depth, clinical severity, and surgical needs.
- Analysis of clinical findings, associations, and outcomes.
Main Results:
- Infections classified as cellulitis, necrotizing fasciitis, or myositis/myonecrosis.
- Neonates comprised the majority of cases (10/14).
- Common associations included omphalitis, necrotizing enterocolitis, and urachal anomalies. Polymicrobial infections were seen in severe cases. Key signs for severe infections were tachycardia, systemic toxicity, severe edema, and disproportionate pain. Dusky or gangrenous skin indicated need for debridement.
Conclusions:
- Soft tissue infections of the abdominal wall in children, particularly necrotizing fasciitis, carry significant mortality risk.
- Early recognition of specific clinical signs is vital for prompt, radical surgical debridement.
- Delayed diagnosis and treatment are associated with poor outcomes.
Abstract:
Soft tissue infections of the abdominal wall in 14 children were classified as cellulitis (8), necrotizing fasciitis (5), or myositis/myonecrosis (1). These 3 categories were characterized by increasing anatomic depth of infection, clinical severity, and need for more radical surgical treatment. Ten of the 14 children were neonates. The most frequent associations were omphalitis (5), necrotizing enterocolitis (4), and urachal anomalies (3). The severest infections were usually polymicrobial and contained both aerobic and anaerobic bacteria. Important clinical findings in children with necrotizing fasciitis and myositis/myonecrosis were tachycardia, systemic toxicity, severe edema, and, in older children, pain out of proportion to the apparent degree of infection. None of the children had fever or crepitation of the wound. An ominous sign, indicative of the need for immediate, radical debridement was the appearance of a patch of dusky or gangrenous skin. There were two deaths associated with delayed diagnosis of necrotizing fasciitis. One child did not receive radical debridement, and the other received it too late to be of benefit. Although these infections are rare in children, their lethal potential and early diagnostic signs must be recognized.