Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture--case report. 2014

Vanja Pecic, and Milica Nestorovic, and Predrag Kovacevic, and Dragan Tasic, and Goran Stanojevic
Clinic for General Surgery, Clinical Center Nis, Nis, Serbia. acrepus@yahoo.com.

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.

UI MeSH Term Description Entries
D007416 Intestinal Perforation Opening or penetration through the wall of the INTESTINES. Intestinal Perforations,Perforation, Intestinal,Perforations, Intestinal
D008297 Male Males
D010538 Peritonitis INFLAMMATION of the PERITONEUM lining the ABDOMINAL CAVITY as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the PERITONEAL CAVITY via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the ABDOMINAL CAVITY itself through RUPTURE or ABSCESS of intra-abdominal organs. Primary Peritonitis,Secondary Peritonitis,Peritonitis, Primary,Peritonitis, Secondary
D002432 Cecum The blind sac or outpouching area of the LARGE INTESTINE that is below the entrance of the SMALL INTESTINE. It has a worm-like extension, the vermiform APPENDIX. Cecums
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D004630 Emergencies Situations or conditions requiring immediate intervention to avoid serious adverse results. Emergency
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000007 Abdominal Injuries General or unspecified injuries involving organs in the abdominal cavity. Injuries, Abdominal,Abdominal Injury,Injury, Abdominal
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014949 Wounds, Nonpenetrating Injuries caused by impact with a blunt object where there is no penetration of the skin. Blunt Injuries,Injuries, Nonpenetrating,Injuries, Blunt,Nonpenetrating Injuries,Blunt Injury,Injury, Blunt,Injury, Nonpenetrating,Nonpenetrating Injury,Nonpenetrating Wound,Nonpenetrating Wounds,Wound, Nonpenetrating

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