Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency.
OBJECTIVE
We reviewed the cases of 23 patients who were admitted to the hospital with a primary diagnosis of histopathologically confirmed necrotizing fasciitis in the lower abdomen or pelvis. Rapid demise of a healthy postpartum women piqued our interest in trying to identify the early signs and symptoms that may lead to earlier diagnosis and treatment of this often fatal disease.


METHODS
A retrospective analysis of charts of all patients who were admitted to the gynecology and obstetrics services of our hospital systems with a diagnosis of necrotizing fasciitis for the past 14 years was performed. Age, comorbid factors, precipitating events, weight, symptoms and signs, microbiologic factors, radiographs, surgical therapy, and morbidity were correlated.


RESULTS
Definitive operation was accomplished within 48 hours of the diagnosis of necrotizing fasciitis in all but 3 patients. Of the 17 patients who were not puerperal, 88% of the women were obese; 65% of the women were hypertensive, and 47% of the women were diabetic. Of the total 23 patients, 70% of the women complained of severe pain, and 35% of the women had radiographic diagnostics for necrotizing fasciitis ("gas"). Four patients had diverting colostomies, and 39% of the patients had flaps or synthetic grafts. Three patients died (mortality rate, 13%). One patient who was puerperal died of a severe rapid septicemia; the 2 late deaths were the result of systemic candidiasis.


CONCLUSIONS
Necrotizing fasciitis is a rapidly progressive, often lethal, infectious disease process that requires early aggressive debridement. Any patient with inordinate pain and unilateral edema in the pelvis, especially in the puerperium, should be suspected of having this disease. Radiographic studies are often diagnostic of this condition. The triad of pelvic pain, edema, and any sign of septicemia carries an extremely grave prognosis and mandates immediate surgical intervention.
Department of Obstetrics and Gynecology, Mercer University School of Medicine, Savannah, Memorial Health University Medical Center, Georgia, USA.
Donald G
DG
Gallup
Murray A
MA
Freedman
Ramon V
RV
Meguiar
Sandra N
SN
Freedman
Thomas E
TE
Nolan
D015746:Abdominal Pain / Q000209:etiology / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003646:Debridement; D048909:Diabetes Complications; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D000292:Pelvic Inflammatory Disease / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D011645:Puerperal Infection / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies