Journal of the Chinese Medical Association
Volume 71, Issue 5 , Pages 259-261, May 2008

Severe Necrotizing Fasciitis of the Abdominal Wall Secondary to Colon Perforation in a Child

  • Hsin-Lin Tsai

      Affiliations

    • Divisions of Pediatric Surgery
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Chin-Su Liu

      Affiliations

    • Divisions of Pediatric Surgery
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Jei-Wen Chang

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Chou-Fu Wei

      Affiliations

    • Divisions of Pediatric Surgery
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Jin-Teh Lin

      Affiliations

    • Reconstruction and Plastic Surgery, Department of Surgery, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Tai-Wai Chin

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital
    • Corresponding Author InformationCorrespondence to: Dr Tai-Wai Chin, Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C

Received 13 August 2007; accepted 14 January 2008.

Article Outline

We discuss the successful saving of an 18-month-old boy with necrotizing fasciitis of the abdominal wall secondary to colon perforation and peritonitis. The patient underwent emergency surgery with exploratory laparotomy, repeated procedures of debridement, and reconstructive abdominal wall surgery with skin graft. He recovered 6 months after admission. We also address the issue of the closure of large abdominal wall defect and the importance of alimentation in this patient group. We discuss the need to recognize necrotizing fasciitis as a potential complication of intra-abdominal disease, as once necrotizing fasciitis occurs, mortality is more likely. We conclude that recognition and aggressive surgical debridement is mandatory. [J Chin Med Assoc 2008;71(5):259–261]

Key Words:  necrotizing fasciitis , split thickness skin graft

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Lodha A , Wales PW , James A , Smith CR , Langer JC . Acute appendicitis with fulminant necrotizing fasciitis in a neonate . J Pediatr Surg . 2003;38:E5–E6
  2. Ameh EA , Nmadu PT . Major complications of omphalitis in neonates and infants . Pediatr Surg Int . 2002;18:413–416
  3. Bodemer C , Panhans A , Chretien-Marquet B , Cloup M , Pellerid D , De Prost Y . Staphylococcal necrotizing fasciitis in the mammary region in childhood: a report of five cases . J Pediatr . 1997;131:466–469
  4. Hsieh WS , Yang PH , Chao HC , Lai JY . Neonatal necrotizing fasciitis: a report of three cases and review of the literature . Pediatrics . 1999;103:e53
  5. Wong CH , Chang HC , Pasupathy S , Khin LW , Tan JL , Low CO . Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality . J Bone Joint Surg Am . 2003;85:1454–1460
  6. Forbes N , Rankin AP . Necrotizing fasciitis and non steroidal anti-inflammatory drugs: a case series and review of the literature . N Z Med J . 2001;114:3–6
  7. Fustes-Morales A , Gutierrez-Castrellon P , Duran-Mckinster C , Orozco-Covarrubias L , Tamayo-Sanchez L , Ruiz-Maldonado R . Necrotizing fasciitis: report of 39 pediatric cases . Arch Dermatol . 2002;138:893–899
  8. Hsieh T , Samson LM , Jabbour M , Osmond MH . Necrotizing fasciitis in children in eastern Ontario: a case-control study . CMAJ . 2000;163:393–396
  9. Schmid MR , Kossmann T , Duewell S . Differentiation of necrotizing fasciitis and cellulitis using MR imaging . AJR Am J Roentgenol . 1998;170:615–620
  10. Elliott D , Kufera JA , Myers RAM . The microbiology of necrotizing soft tissue infections . Am J Surg . 2000;179:361–366
  11. Ou LF , Yeh FL , Fang RH , Yu KW . Bacteriology of necrotizing fasciitis: a review of 58 cases . J Chin Med Assoc . 1993;51:271–275
  12. Chen YM , Tarng DC , Wang LS . Necrotizing fasciitis with toxicshock like syndrome . J Chin Med Assoc . 1990;46:117–120
  13. Jallali N , Withey S , Butler PE . Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis . Am J Surg . 2005;189:462–466

PII: S1726-4901(08)70117-5

doi:10.1016/S1726-4901(08)70117-5

Journal of the Chinese Medical Association
Volume 71, Issue 5 , Pages 259-261, May 2008

Article Tools