title: Trocar-site hernia complicated by necrotizing fasciitis--case report and review of the literature.
abstract: Only a few reports have been published describing necrotizing soft tissue infection (NSTI) following laparoscopic surgery; none identify trocar-site hernia as an etiologic factor. We present a case report and review of the literature. A 43-year-old previously healthy man underwent uneventful laparoscopic cholecystectomy. An unrecognized strangulated lateral trocar-site hernia resulted in fatal NSTI. A Medline database search (1966-2002) identifies ten detailed reports of NSTIs following laparoscopic surgery. Multiple risk factors were identified in almost all patients. The mortality rate was 20%. Patient survival from NSTI requires early recognition, aggressive surgical intervention, and intensive medical care. NSTI can occur following minimally invasive surgery, and physicians should maintain a high index of suspicion when patients begin to develop postoperative symptoms. Trocar-site hernia arises as another etiologic factor for NSTI in the domain of minimally invasive surgery.
authors.affiliation: Department of Surgery M580 Health Sciences Center, University of Missouri-Columbia School of Medicine, One Hospital Drive, Columbia, MO 65212, USA..
authors.forename: J E
authors.initials: JE
authors.lastname: Losanoff
authors.forename: B W
authors.initials: BW
authors.lastname: Richman
authors.forename: J W
authors.initials: JW
authors.lastname: Jones
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D019115:Fasciitis, Necrotizing / Q000209:etiology*; D017809:Fatal Outcome; D006547:Hernia / Q000209:etiology*; D006801:Humans; D008297:Male