Catastrophic necrotizing fasciitis after blunt abdominal trauma with delayed recognition of the coecal rupture – case report

Necrotizing fasciitis (NF) is a rare bacterial infection with dramatic course, characterized by widespread necrosis of the skin, subcutaneous tissue, and superficial fascia which can often lead to death.
We present a case of 27 year old male with NF. He was admitted to the regional hospital the day after blunt abdominal trauma. The following day he was referred to our hospital where he was operated on urgently. Previously he was treated in a regional hospital immediately after injury for diffuse abdominal pain and large hematoma of anterior abdominal wall. Injury was obtained while driving a bike and falling over handlebar. Due to worsening of general condition he was referred to our hospital. Surgery revealed rupture of the coecum with peritonitis and abdominal wall infection. After surgery the fulminant necrotizing fasciitis has developed. The antibiotics were prescribed according to wound cultures. Subsequent necrectomies were performed and after 25 days the reconstruction of abdominal wall with skin graft was obtained. Despite all resuscitation measures including fluids, blood transfusions and parenteral nutrition, the lung infection and MODS caused death 42 days after initial operation.
Blunt abdominal trauma could bring rupture of intestine, and in early signs of peritoneal irritation the emergency laparotomy should be performed. Disastrous complication are rare but lethal.