Necrotizing fasciitis is a rapidly progressive soft tissue infection that involves subcutaneous fat and spreads along the fascial planes. This disease has a potentially fatal outcome if not recognized in early. Several cases have been reported of a possible association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and the development or aggravation of necrotizing fasciitis. This association is still a subject of controversy. In this article we present a case of fatal necrotizing fasciitis occurring in association with intramuscular injections of diclofenac in a patient who was admitted for the symptoms of a urinary stone. Our opinion is that the intramuscular injections caused a locally aseptic necrosis, which was secondarily invaded by. Since this incident, our policy is to avoid the use of intramuscular injections of diclofenac and other NSAIDs in cases of potentially infectious diseases.

No abstract

Pseudoaneurysm of the left hepatic artery in a patient with chronic pancreatitis complicated with obstructive jaundice. A pseudoaneurysm of the left hepatic artery that causes an obstructive jaundice is a rare entity that has only been described a few times in scientific literature. We describe the case of a patient with a giant pseudoaneurysm (10 cm diameter) caused by chronic pancreatitis, that compresses the choledochus duct. The diagnosis was made by CT scan (computed tomography). The treatment consisted of a ligation of the afferent and efferent artery and evacuation of the aneurysmatic mass. A persisting bile leak was caused by a haemobiliary fistula between the aneurysmatic sac and choledochus duct. Therefore, a hepaticojejunostomy was performed with a delay of 4 weeks. The patient recovered after a few weeks and left the hospital in a good condition.