Necrotizing fasciitis, poor hygiene and negligence in obese patients

Abstract

The Tegument, the body's largest organ, also fulfills the protective function by preventing the pathogens from penetrating into the body. The barrier, once overcome, opens the gate to serious illnesses with varying degrees of severity. We present the case of an obese patient aged 63, BMI 40, admitted to emergency service for necrotizing fasciitis in the abdominal wall. Anamnesis and general clinical examination highlight the presence of a large area of necrosis in the lower abdominal wall, affecting the iliac fossa, the hypogastric region and the left iliac fossa, lack of substance at this level, limited supraaponvrotic, with multiple sepsis, isolated tissue areas granulation, anfractum edges, suggestive aspect for necrotizing fasciitis. Serious surgical interventions have been carried out, with the aim of broad, digital and instrumental debridement, the important lavage of the wound with hydrogen peroxide and betadine and antibiotic treatment according to the antibiogram. Subsequently, dressings were applied with negative pressure, with development of granulation tissue in the wound and in the end was chosen for secondary suture with favorable outcome and discharge from the hospital 33 days after admission. Precarius socio-economic status, poor hygiene in an obese, careless patient, without identifying other causes like diabetes or surgical history, have led to the development of a multilingual, life-threatening condition. Serious surgical attitude and postoperative care have led to a medical success, although burdened by significant costs, which could have been avoided with minimal effort especially from the patient.