title: Necrotising fasciitis after hysterectomy and concomitant transvaginal mesh repair in a patient with pelvic organ prolapse.
abstract: Necrotising fasciitis is a severe form of soft tissue infection. Herein, we present an unreported complication of the transvaginal repair of a pelvic organ prolapse (POP) with trocar-guided polypropylene mesh and a concomitant hysterectomy. A 61-year-old Caucasian female who had been using an intrauterine device (IUD) for 30 years presented with a stage 3 pelvic organ prolapse. A genital ultrasound examination confirmed the presence of an IUD, but found no endometrial abnormalities. The surgical management was limited to a transvaginal hysterectomy and simultaneous anterior vaginal wall repair augmented with trocar-guided mesh. A morphological examination of the removed uterus confirmed the presence of the intrauterine device and additionally found endometrial cancer (T1N0M0), which was not revealed during the preoperative ultrasound. Within 6 days of the surgery, she developed anaerobic bilateral necrotising fasciitis on both thighs. Non-clostridial streptococci were identified in the wound. After 18 days of intensive care, the patient died of fatal coagulopathy.
authors: Urology Department, Moscow State University of Medicine and Dentistry, 127206, Vucheticha 21, Moscow, Russia.
authors: Dmitry Y
authors: DY
authors: Pushkar
authors: Mikhail I
authors: MI
authors: Vasilchenko
authors: George R
authors: GR
authors: Kasyan
mesh_terms: D016889:Endometrial Neoplasms / Q000175:diagnosis; D019115:Fasciitis, Necrotizing / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007434:Intrauterine Devices; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D013290:Streptococcal Infections / Q000209:etiology*; D013525:Surgical Instruments; D013526:Surgical Mesh
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