Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture – case report

Abstract

Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death. We present a case of a 27-year-old male with NF. One day after experiencing blunt abdominal trauma caused by falling over bike handlebars, the patient was admitted to a regional hospital and treated for diffuse abdominal pain and large hematoma of the anterior abdominal wall. Due to worsening of general condition, he was referred to our hospital the following day and operated on urgently. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery, fulminant necrotizing fasciitis developed. Antibiotics were prescribed according to wound cultures and subsequent necrectomies were performed. After 25 days, reconstruction of the abdominal wall with skin grafts was obtained. Despite all resuscitation measures including fluids, blood transfusions, and parenteral nutrition, lung infection and MODS caused death 42 days after initial operation. Blunt abdominal trauma can cause the rupture of intestine, and if early signs of peritoneal irritation should present, emergency laparotomy should be performed. Disastrous complication are rare but lethal.

Necrotizing soft tissue infections of perianal and perineal region - still lethal infection

“…In two of these patients, infection followed perforations of the rectum and sigma, while the other patients indicated previous injuries with existing hematomas of the gluteal region and the region of the front abdominal wall. The literature data on the existence of NSTI with different localizations, occurring through the perforation of the hollow organs of the abdominal cavity, have been mostly presented as rare case reports [1,[17][18][19][20][21][22][23]. In relation to the origin of NSTI,…”