title: Abdominal wall infected ischemic necrosis mimicking necrotizing fasciitis.
abstract: Emergency surgery to revascularize an ischemic leg in the presence of an aortic aneurysm presents a series of difficult management decisions in both the operative and postoperative phases. We present a case of infected ischemic necrosis that developed in a discrete tissue plane from a transverse incision mimicking necrotizing fasciitis. A 57-year-old man presented with an ischemic leg associated with a 5-cm abdominal aortic aneurysm. The sudden appearance of gangrenous tissue in the inferior flap of the transverse abdominal incision prompted urgent surgical debridement. This case report describes the management of a potentially misleading clinical condition. The key points to remember are to maintain a high index of suspicion for potentially life-threatening soft tissue infections, to be vigilant about regular wound inspection, and to act decisively when urgent wound debridement is indicated.
authors.affiliation: Countess of Chester Hospital, Chester CH2 1UL, UK.
authors.forename: Paul David
authors.initials: PD
authors.lastname: Ainsworth
authors.forename: Linda
authors.initials: L
authors.lastname: de Cossart
mesh_terms: D034861:Abdominal Wall / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003646:Debridement; D003937:Diagnosis, Differential; D019115:Fasciitis, Necrotizing / Q000175:diagnosis*; D005734:Gangrene; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009336:Necrosis; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology / Q000601:surgery