Necrotizing Fasciitis After Laparoscopic Colonic Surgery: Case Report and Review of the Literature

Practical Review of Necrotizing Fasciitis: Principles and Evidence-based Management

Necrotizing fasciitis is a severe, life-threatening soft tissue infection that presents as a surgical emergency. It is characterized by a rapid progression of inflammation leading to extensive tissue necrosis and destruction. Nonetheless, the diagnosis might be missed or delayed due to variable and nonspecific clinical presentation, contributing to high mortality rates. Therefore, early diagnosis and prompt, aggressive medical and surgical treatment are paramount. In this review, we highlight the defining characteristics, pathophysiology, diagnostic modalities, current principles of treatment, and evolving management strategies of necrotizing fasciitis.

Clostridial Gas Gangrene of the Abdominal Wall After Laparoscopic Cholecystectomy: A Case Report and Review

Clostridial gas gangrene is a rare, yet severe, complication after laparoscopic cholecystectomy. We present a case report of a 48-year-old man with obesity, coronary artery disease, and diabetes, who developed clostridial gas gangrene of the abdominal wall after an uncomplicated laparoscopic cholecystectomy. Although the diagnosis was missed initially, successful radical surgical debridement was performed and the patient survived. Pathogenesis, symptoms, prognostic factors, and the best treatment are discussed.

Necrotising fasciitis after laparoscopic rectal cancer surgery

Necrotising fasciitis is a rare, serious infection of the deep fascia leading to subcutaneous tissue necrosis. It is extremely important for this condition to be identified and treated promptly as it bears significant mortality. We describe a case of necrotising fasciitis after laparoscopic rectal cancer surgery. To our knowledge, this is the first case reported after the specific procedure. This case report aims to encourage surgeons to have a low threshold in recognising necrotising fasciitis postoperatively, especially for patients with possible risk factors.

Severe cellulitis and abdominal wall emphysema following laparoscopic colonic surgery: A case report

Abdominal wall emphysema is a common complication of laparoscopic surgery. This condition is usually harmless; however, if an infection occurs, it can develop into a serious condition such as necrotizing fasciitis. We report a case of a 51-year-old woman suffering from severe cellulitis that spread from an area of abdominal wall emphysema after laparoscopic surgery for sigmoid colon cancer. Recognizing this complication, early diagnosis, and prompt treatment are cornerstones for successful management of this potentially fatal disease.

Common postoperative findings unique to laparoscopic surgery

The interpretation of images obtained in patients who have recently undergone abdominal or pelvic surgery is challenging, in part because procedures that were previously performed with open surgical techniques are increasingly being performed with minimally invasive (laparoscopic) techniques. Thus, it is important to be familiar with the normal approach used for laparoscopic surgeries. The authors describe the indications for various laparoscopic surgical procedures (eg, cholecystectomy, appendectomy, hernia repair) as well as normal postoperative findings. For example, port site hernias are more commonly encountered in patients with trocar sites greater than 10 mm and occur at classic entry sites (eg, the periumbilical region). Similarly, preperitoneal air can be encountered postoperatively, often secondary to trocar dislodgement during difficult entry or positioning. In addition, intraperitoneal placement of mesh during commonly performed ventral or incisional hernia repairs typically leads to postoperative seroma formation. Familiarity with normal findings after commonly performed laparoscopic surgical procedures in the abdomen and pelvis allows accurate diagnosis of common complications and avoidance of diagnostic pitfalls.

Imaging of complications associated with port access of abdominal laparoscopic surgery

Advanced techniques and equipment in laparoscopic surgery offer advantages over open surgery, expanding the application of this minimally invasive procedure to a wide range of abdominal operations that used to be performed as an open procedure. Laparoscopic surgery is performed in the closed abdominal cavity in which the space is limited. To create a working space in the abdominal cavity, an artificial pneumoperitoneum is established and multiple ports are placed for the introduction of various laparoscopic instruments. Unlike open surgery in which the incision is made just above the target organ, laparoscopic access is made away from the area of dissection, with the instruments triangulated around the target organ within the abdomen. This fundamental difference in approach between the open and laparoscopic procedures may lead to peculiar postoperative complications after laparoscopic surgery, which may be present away from the target organ or in the abdominal wall, and be easily missed on postoperative imaging studies. These complications include port-related direct organ injuries, such as abdominal organ or vascular injury; abdominal wall complications related to laparoscopic port insertion such as vascular injury, infection, and hernia; abdominal wall complications related to specimen removal, such as port site tumor seeding and endometriosis; and complications related to gas insufflation. The radiologist plays an important role in the diagnosis of complications after laparoscopic surgery, and therefore should be familiar with the features of such complications on imaging scans in the era of laparoscopic surgeries.

Necrotizing fasciitis following laparoscopic left hemicolectomy for diverticulitis

Necrotizing fasciitis (NF) is a rapidly progressing bacterial infection of soft skin tissue layers, combined with high mortality rates. Association with laparoscopic surgery is rare. In this article, we report a case of a 61-year-old patient suffering from severe NF after laparoscopic left hemicolectomy with low anterior resection due to diverticulitis of sigmoid colon. Skin discolorations, combined with critical illness of the patient, led to the diagnosis of NF. Early recognition, intensive care treatment with stabilization of vital parameters, broad-band antibiotics, and aggressive debridement are the cornerstones for successful treatment of NF.

Postprocedural Necrotizing Fasciitis: A 10-Year Retrospective Review

Necrotizing fasciitis (NF) is a severe soft tissue infection, which has a reported 25 per cent to 60 per cent mortality rate. In addition, NF has been reported to occur after invasive procedures. We present a 10-year retrospective study on postprocedural NF and its differences with community-acquired NF. A retrospective study was conducted from 1996 to 2006. Charts were searched using International Classification of Diseases, 9th Revision codes for NF and gas gangrene. Patients who developed NF in the area of their previous procedure without any other inciting cause of the NF were deemed eligible for the study. Eleven patients met eligibility criteria. Seven patients’ initial procedures were elective, whereas four were semiemergent. The median age was 48 years (range, 24–81 years). The time between the initial procedure and operation for NF varied from 3 days to over 3 months. No single laboratory value helped in diagnosing NF. Sixteen different bacteria were isolated from the 11 patients. Ten of 11 patients required multiple débridements. There were four mortalities, three of whom had comorbidities known to predispose to infection. NF is a rare but serious complication after invasive procedures. As a result of important differences that exist between postprocedural and community-acquired NF, we propose that postprocedural NF should be classified in its own subcategory.