Lethal Necrotizing Cellulitis Caused by ESBL-Producing E. Coli after Laparoscopic Intestinal Vaginoplasty.
BACKGROUND
The absence of a functional vagina has a negative effect on the quality of life of women. Multiple surgical procedures have been described for vaginal reconstruction in these patients.


METHODS
We present a case of an 18-year-old transgender woman, who underwent laparoscopic intestinal vaginoplasty as vaginal reconstruction, and subsequently developed septic shock and multiple organ failure on the basis of an extended-spectrum β-lactamase-producing Escherichia coli. A severe progression of the necrotizing fasciitis was lethal, despite repeated surgical debridement, intravenous antibiotic use, and supportive care at the intensive care unit.


CONCLUSIONS
Although vaginal reconstruction has a positive influence on the quality of life in transgender women, physicians and patients need to be aware of serious complications that might arise.
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Vera L
VL
Negenborn
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
Wouter B
WB
van der Sluis
Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands; Department of Gastro-intestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, The Netherlands.
Wilhelmus J H J
WJHJ
Meijerink
Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: mark-bram.bouman@vumc.nl.
Mark-Bram
MB
Bouman
D000293:Adolescent; D002481:Cellulitis / Q000382:microbiology*; D004926:Escherichia coli / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D010502:Perineum / Q000601:surgery; D011183:Postoperative Complications / Q000382:microbiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D063106:Transgender Persons; D014621:Vagina / Q000601:surgery; D001618:beta-Lactamases / Q000378:metabolism; D008297:Male
D001618:beta-Lactamases
Necrotizing fasciitis; Postoperative complications; Reconstructive surgical procedures; Vaginoplasty