Necrotizing fasciitis secondary to diverticulitis

Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.     

Necrotizing fasciitis: an urgent diagnosis

Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests—e.g., the “finger test” or biopsy—and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging.     

Necrotizing fasciitis: unreliable MRI findings in the preoperative diagnosis

The authors present two cases of necrotizing fasciitis (NF), one case of dermatomyositis and one case of posttraumatic muscle injury, which have similar magnetic resonance imaging findings in terms of skin, subcutaneous fat, superficial and deep fasciae and muscle involvement. These cases highlight the need for cautious interpretation of magnetic resonance imaging (MRI) findings, for they are nonspecific and the preoperative decision should be based mostly on the evolution of the clinical status.     

Necrotizing fasciitis of the knee following primary total knee arthroplasty

Necrotizing fasciitis is a rare, life-threatening and rapidly spreading soft-tissue infection that results in necrosis of the muscle, fascia and surrounding tissue. It can be result of a polymicrobial synergistic infection or a streptococcal infection. The authors report a case of necrotizing fasciitis occurring in the knee of a 65-year-old woman following an uneventful primary total knee arthroplasty and resulting in above-the-knee amputation. Having in mind severe infections like necrotising fasciitis, one should be aware of the possibility of such postoperative complications especially in patients with risk factors even in routine procedures like a total knee arthroplasty.     

Necrotizing fasciitis with fatal outcome: a report of two cases

Two cases of sudden and unexpected death due to necrotizing fasciitis are presented with a short overview of this rare disease with special reference to pathological features and causative and epidemiological factors. One case occurred as a complication of liposuction surgery, and the second presented after minor trauma. Based on the autopsy findings and an interdisciplinary approach, medico-legal evaluation provides a substantial basis for later court hearings in such cases.     

A case series of group A Streptococcus necrotizing fasciitis in military trainees

We describe a case series of group A Streptococcus (GAS) necrotizing fasciitis occurring over a 10-week period in military recruits undergoing intense physical training. These cases highlight that GAS may cause life-threatening infections in addition to mild diseases such as pharyngitis. This series suggests that the incidence of severe GAS infections may be increasing in certain populations and it emphasizes the importance of considering prophylactic measures against GAS in high-risk populations.     

Necrotizing fasciitis secondary to perforated sigmoid colon diverticulitis: Computed tomographic demonstration

We report a case of necrotizing fasciitis of the abdominal wall secondary to perforated sigmoid colon diverticulitis. Management consisted of immediate debridement of necrotic tissue, exploratory laparotomy, sigmoid and left hemicolectomy, and colostomy. Computed tomography played a critical role in this case by demonstrating diverticulitis and obstruction of the sigmoid colon as the underlying cause of the disease and the presence as well as extent of necrotizing fasciitis. Although rare, gastrointestinal tract pathology should be considered as a potential etiology of necrotizing fasciitis of the abdominal wall in patients without a history of abdominal wall trauma or surgery.     

Sentinel case of group A beta-hemolytic streptococcus causing constrictive pericarditis presenting as hypogammaglobulinemia

This is a unique case of a previously healthy 7-year-old boy, which highlights the importance of considering immunodeficiency when a rare infection occurs. In the following case report, the patient develops constrictive pericarditis secondary to group A beta-hemolytic streptococcal infection. As a result of this infection, we speculate that he develops hypogammaglobulinemia secondary to the documented association between constrictive pericarditis and intestinal lymphangiectasia because an extensive work-up for a primary immunodeficiency was negative. This is the first case ever to present constrictive pericarditis because of group A beta-hemolytic streptococcal infection.     

右肩部及右上肢坏死性筋膜炎1例报告

我院收治1例右肩部、右上肢坏死性筋膜炎患者,行切开减压、彻底清创术,术后予以VSD负压吸引,同时应用大量有效抗生素以及营养支持治疗,疗效满意。     

Necrotizing fasciitis of soft tissues: role of diagnostic imaging and review of the literature

PURPOSE: We retrospectively reviewed the diagnostic imaging findings (radiography, CT and US) of our cases of necrotizing fascitis of soft tissues looking for signs that could be useful for early and accurate diagnosis. MATERIAL AND METHODS: May 1991 to February 1998 we examined 130 patients with progressive necrotizing soft tissue infections; in 32 of them (22-84 years old) the retrospective pathologic diagnosis was necrotizing fascitis. Involved sites were the limbs (26/32), the cervical region (5/32) and the perineal region (1/32). Nineteen patients were submitted to conventional radiography, also for soft tissue studies. US was performed in an emergency setting in all the 32 cases, by a selected group of US operators particularly skilled in this kind of soft tissue condition. Contrast enhanced CT was performed in 9 cases. RESULTS: B-mode and Doppler US yielded useful and reliable information for prompt and correct diagnosis. Particularly these techniques showed changes in subcutaneous adipose tissue (28/32), fascia (18/32) and muscle (15/32). We found a good correlation between tissue changes as shown at US and histologic findings, but US missed changes in subcutaneous soft tissue and muscle in 11 cases (3/32 and 8/32, respectively) with subsequent histologic confirmation. Contrast enhanced CT better defined the extent of disease and possible complications, especially in sites that are difficult to study with US. DISCUSSION AND CONCLUSIONS: Early diagnosis and proper treatment are the key issues affecting the chances of recovery for patients with necrotizing fascitis. The clinical suspicion of this condition calls for prompt intervention with effective diagnostic protocols. B-mode, and sometimes color Doppler, US and contrast enhanced CT, together with appropriate laboratory tests, can provide useful information for precise diagnosis and proper treatment.     

车祸伤术后并发肠外瘘及肛周坏死性筋膜炎的护理

肛周坏死性筋膜炎(perianal necrotizing fascitis,PNF)病情进展迅速,如果不能迅速的作出诊断并给予处理,可很快进展为脓毒血症,甚至导致患者死亡.其治疗原则是早期切开引流.但在临床救治过程中,由于肛周容易受到粪便和肠道分泌物的污染,即使清创、引流和应用大剂量广谱抗生素,死亡率仍高达31.5%[1].我科于2008年10月收治了1例外科手术后并发肠外瘘及肛周坏死性筋膜炎的患者,经积极正确的治疗和护理,挽救了患者的生命,现将护理体会介绍如下.     

海岛地区虫咬伤致下肢坏死性筋膜炎治疗策略

目的探讨海岛地区虫咬伤致下肢坏死性筋膜炎的临床特点及治疗方法。方法回顾性分析自2010年1月至2014年12月解放军第四一三医院收治的虫咬伤致下肢坏死性筋膜炎患者的临床资料,分析总结治疗经验。结果本组患者经控制感染,积极行负压治疗及手术,创面全部愈合。结论海岛地区气候易引发虫咬伤,应引起重视预防。采用积极治疗基础疾病,控制感染清创手术,有效避免截肢。