Abdominal wall infected ischemic necrosis mimicking necrotizing fasciitis.
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.
Ainsworth
Paul David
PD
Countess of Chester Hospital, Chester CH2 1UL, UK.
de Cossart
Linda
L
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