Necrotizing Fasciitis of the Abdominal Wall Caused by Invasive Group D <italic>Enterococcus faecalis</italic> Secondary to Infected Intra-abdominal Drainage

Abstract

Necrotizing fasciitis (NF) is a relatively rare soft-tissue infection that is characterized by rapidly widespread necrosis of the fascia and subcutaneous tissue. We discuss the successful saving of an 80-year-old woman with necrotizing fasciitis of the abdominal wall caused by invasive group D Enterococcus feacalis, secondary to postoperative drainage inserted during right hemicolectomy for colon cancer. Other factors such as a long hospital stay before surgical intervention, chronic anemia secondary to intestinal haemorrhage due to angiodysplasia, multiple preoperative transfusions of blood and chronic hepatopathy secondary to virus hepatitis B favoured its development. The patient underwent repeated procedures of debridement, and was treated with respiratory and hemodynamic support, broadspectrum antibiotics, parenteral and enteral nutrition. She recovered forty days after admission to the Intensive Care Unit. We discuss the need to recognize necrotizing fasciitis as a potential complication of infected postoperative drainage, as once necrotizing fasciitis occurs, mortality is more likely. It is also important to point out that intraabdominal drainage should be placed with great care due to the severity of possible complications. We conclude that recognition and aggressive surgical debridement of NF is mandatory. We also address the issue of the importance of respiratory and hemodynamic support and alimentation in these patients. 10 , laparoscopic colonic surgery 11 , artery cannulation 12 , and along the surgical sutures or at the drain site in the abdominal wall after operation in the abdomen 13 , as in our case. To our knowledge, this is the first case of NF associated with postoperative intraabdominal drainage after colon surgery. This article reviews the epidemiology, aetiology, pathogenesis, clinical diagnosis, radiological examinations, laboratory tests and management principles of this entity.