Journal List > Korean J Obstet Gynecol > v.55(9) > 1088513

TOOLS
Mun, Cho, Kim, Nam, and Lee: A case of necrotizing fasciitis after cesarean delivery
Case Report
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2012; 55(9): 659-663.

Published online: 17 September 2012

DOI: https://doi.org/10.5468/KJOG.2012.55.9.659

A case of necrotizing fasciitis after cesarean delivery

Ga-Ul Mun, MD1, Eun-Kyu Cho, MD1, Yun-Sook Kim, MD1, Du-Hyun Nam, MD2, Hyun-Ju Lee, MD3

1Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, University of Soonchunhyang College of Medicine, Cheonan, Korea.

2Department of Plastic Surgery, Soonchunhyang University Cheonan Hospital, University of Soonchunhyang College of Medicine, Cheonan, Korea.

3Department of Pathology, Soonchunhyang University Cheonan Hospital, University of Soonchunhyang College of Medicine, Cheonan, Korea.

Corresponding author: Yun-Sook Kim, MD. Department of Obstetrics and Gynecology, Soonchunhyang University Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan 330-930, Korea. Tel: +82-41-570-2150, Fax: +82-41-571-7887, drsook@schmc.ac.kr

Received 16 May 2012       Revised 16 July 2012       Accepted 26 July 2012

Copyright © 2012. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Necrotizing fasciitis (NF) is a rare, rapidly progressive and potentially fatal soft-tissue infection characterized by widespread severe infection of the deep soft tissue, including fascia. Predisposing conditions for NF include diabetes, malignancy, obesity, and chronic liver disease. Patients with suspected NF should be empirically and immediately managed with broad-spectrum antibiotics covering the commonly suspected organisms. And surgical debridement is the mainstay of treatment of NF. We experienced a very rare case of NF with 33-year-old healthy woman who presented with high fever, erythema, edema, and pustule on upper abdomen one day after cesarean section. NF was strongly suspected and immediate surgical intervention and broad spectrum antibiotics were used. We report it with a brief review of literatures.

Keywords: Necrotizing fasciitis, Cesarean delivery, Surgical intervention

Figures and Tables

Fig. 1
Abdomen and pelvis computed tomography showed subcutaneous multiple free airs (arrow) and diffusely infiltrated subcutaneous tissue of bilateral lower abdominal wall.
kjog-55-659-g001
Fig. 2
Multiple dark colored necrotic tissues in fascia, muscle and subcutaneous layer (arrow).
kjog-55-659-g002
Fig. 3
Microscopic finding of the necrotic subcutaneous tissue with fascia showing acute gangrenous inflammation, necrosis, and diffuse neutrophilic inflammation (H&E, ×100).
kjog-55-659-g003

References

1. Pauzner D, Wolman I, Abramov L, Lidor A, David MP. Post-cesarean-section necrotizing fasciitis: report of a case and review of the literature. Gynecol Obstet Invest. 1994. 37:59–62.
2. Shimizu T, Tokuda Y. Necrotizing fasciitis. Intern Med. 2010. 49:1051–1057.
3. Rea WJ, Wyrick WJ Jr. Necrotizing fasciitis. Ann Surg. 1970. 172:957–964.
4. Majeski JA, Alexander JW. Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis. Am J Surg. 1983. 145:784–787.
5. Wilson B. Necrotizing fasciitis. Am Surg. 1952. 18:416–431.
6. Kotrappa KS, Bansal RS, Amin NM. Necrotizing fasciitis. Am Fam Physician. 1996. 53:1691–1697.
7. Bosshardt TL, Henderson VJ, Organ CH Jr. Necrotizing soft-tissue infections. Arch Surg. 1996. 131:846–852.
8. McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995. 221:558–563.
9. Rubinstein E, Dehertogh D, Brettman L. Severe necrotizing soft-tissue infections: report of 22 cases. Conn Med. 1995. 59:67–72.
10. Choi WM, Hong SP, Kim JH, Cheon SH, Min KO, Moon HB, et al. A case of necrotizing fascitis after Cesarean section. Korean J Obstet Gynecol. 2002. 45:884–887.
11. Elliott DC, Kufera JA, Myers RA. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg. 1996. 224:672–683.
12. Singh G, Sinha SK, Adhikary S, Babu KS, Ray P, Khanna SK. Necrotising infections of soft tissues--a clinical profile. Eur J Surg. 2002. 168:366–371.
13. Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeill EM, Englender SJ. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. JAMA. 1993. 269:384–389.
14. Kaul R, McGeer A, Low DE, Green K, Schwartz B. Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med. 1997. 103:18–24.
15. Frazee BW, Fee C, Lynn J, Wang R, Bostrom A, Hargis C, et al. Community-acquired necrotizing soft tissue infections: a review of 122 cases presenting to a single emergency department over 12 years. J Emerg Med. 2008. 34:139–146.
TOOLS
Similar articles