IntroductionNecrotizing fasciitis is a severe inflammatory disease of the body's soft tissue characterized by spreading rapidly and high mortality. Rapid surgical intervention along with other supportive measures of treatment have a great impact on the outcome of treatment. Material and methodsThis study was conducted by a retrospective medical record review of all patients with a microbiologically and clinically confirmed diagnosis of necrotizing fasciitis who were admitted to the general surgery department at the General Hospital Novi Pazar, Serbia, during the period between 2017 and 2020. Demographic, clinical, laboratory, and microbiology data were analyzed. ResultsA total of 13 cases were identified, which represents 0.21% of the total number of patients treated at the surgical department during the period January 2017 to November 2020. The mean age of patients was 55 years, with a male/female ratio of 1:1.6. All of them had at least one comorbidity and more than half had three or more. Diabetes, cardiovascular diseases, and obesity were the most common comorbidities. The most common causes of infection were Klebsiella spp, Pseudomonas aeruginosa, S. pyogenes, and S. aureus. All patients received multiple surgical interventions (mean 2.3). ConclusionTreating necrotizing fasciitis requires a multidisciplinary approach. Early diagnosis and rapid clinical response allow for better disease outcomes. Getting to know more about necrotizing fasciitis will help doctors make better decisions when treating it.

Introduction. Necrotizing Fasciitis is a rare, severe, aggressive infection, life-threatening surgical emergency that spreads quickly, characterized by extensive necrosis of the deep and superficial fascia, associated with significant morbidity and mortality. Case outline. We are presenting two case reports with Necrotizing Fasciitis: a 54-year-old male patient, obese, with hypertension and untreated perianal fistula with severe infection of perianal region, perineum and scrotum, and 64-year-old female patient with diabetes mellitus and heart disease, with severe infection of the lower extremity, anterior abdominal wall, inguinal and gluteal region, in which the entry point of infection were microlesions of the skin after shaving. Both patients were treated by emergency extensive surgical necrectomy with eradication of the deep infection source, with all conservative treatment measures. The first patient was treated with hyperbaric oxygen therapy, the 2nd wasn't because of cardiac and pulmonary contraindications. Conclusion. Better treatment outcome requires a multidisciplinary approach (cardiologist, endocrinologist, nephrologist, orthopedist, surgeon). Rapid and extensive surgical necrectomy is necessary to increase the success of the treatment of patients with this infection.

Introduction. Trauma is among the leading causes of death. Undetected and untreated adequately and on time, traumatic small bowel injuries can be lethal. Case Report. We present a case of a small bowel perforation after a blunt abdominal injury, caused by an accidental self-inflicted hammer blow to the abdomen. The initial abdominal and chest x-rays and abdominal ultrasound did not indicate an injury to the abdominal organs. Due to the impaired clinical picture and the fact that the patient was hemodynamically stable, multi-detector computed tomography of the abdomen and small pelvis was performed, showing intraperitoneal free fluid and pneumoperitoneum, not seen by other imaging methods. A decision for surgical treatment was made. The intraoperative finding confirmed a small bowel perforation. Conclusion. Due to the possible false-negative imaging findings, clinical follow-up of patients with abdominal trauma is mandatory when making the decision for surgical treatment.

Introduction. Since the announcement of the SARS-CoV-2 pandemic, the health system has been facing great challenges. Due to several uncertainties and concerns, surgeons face a huge challenge in solving urgent surgical conditions in order to save a life. Case report. We present a patient with a coronavirus (COVID-19) infection and acute abdomen who was in poor general condition at the time of surgery, septic, all as a result of duodenal ulcer perforation. She did not have a positive RT-PCR at the time of surgery, but the lung CT scan showed highly indicative signs of COVID-19 infection. She had a positive nasopharyngeal swab RT-PCR test for the SARS-CoV-2 virus on the first postoperative day. Conclusion. All suspected COVID-19 patients during surgery should be treated as positive for SARS-CoV-2 virus with the use of all staff protection measures.

COVID-19 is an unpredictable disease that can lead to multiorgan dysfunctions. There is a high frequency of venous and arterial thrombosis, among other symptoms,. Spontaneous bleeding in COVID-19 patients has also been described, but rarely, whether or not they are on anticoagulant therapy. We report a case of a 65-year-old female COVID-19 patient treated in our hospital. During the hospitalisation, she experienced sudden, severe pain in the lower part of the abdomen and had signs of hemorrhagic shock. CT of the abdomen and pelvis revealed a spontaneous giant haematoma of the anterior abdominal wall. A surgical procedure was done. We identified spontaneous bleeding in the muscles of the anterior abdominal wall. The patient recovered well. Rapid diagnosis and timely intervention are crucial to ensure a good patient outcome.