DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201255

Case report on necrotizing fasciitis following episiotomy

Bhabani Pegu, Jayalakshmi D., Avantika Gupta

Abstract


Necrotising fasciitis (NF) is an extremely rare but near fatal bacterial soft tissue infection, complicating the operative wounds. Here is a case report of Necrotising fasciitis in episiotomy wound in low socioeconomic, poorly nourished and anaemic women. A 39 years old, second gravida, delivered normally with medio-lateral episiotomy under local anaesthesia. On postnatal day four, patient developed high grade fever and on examination episiotomy was found to be unhealthy and gaped. She was started on broad spectrum antibiotics empirically but the cellulitis rapidly progressed to vulva, then to the bilateral thighs and extended till knees. Bilateral lower limb Doppler ultrasonography was done to rule out deep vein thrombosis which showed no abnormality. USG abdomen revealed huge pus collection in the lower abdomen. Under anaesthesia, surgical exploration was done, pus was drained followed by wound debridement and pus sent for culture and sensitivity. Pus and blood culture showed growth of Klebsiella pneumoniae, so started on appropriate antibiotics. Patient started recovering, when the wound was healthy, secondary suturing of episiotomy wound done. She was discharged on post-natal day 27 after full recovery. Early diagnosis and aggressive timely management are the corner stone to avoid morbidity and mortality of NF.


Keywords


Episiotomy, Morbidity, Necrotising fasciitis

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References


Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest. 1996;110(1):219-29.

Fallahzadeh H, Altenbernd E, Mays ET. Necrotizing fasciitis. Am Surg. 1974;40:352-4.

Brook I, Frazier EH. Clinical and microbiological features of necrotizing fasciitis. J Clin Microbiol. 1995;33(9):2382-7.

Golde S, Ledger WJ. Necrotizing fasciitis in postpartum patients. A report of four cases. Obstet Gynecol. 1977;50(6):670-3.

Ammari NN, Hasweh YG, Hassan AA, Karyoute S. Post-partum necrotizing fasciitis. Case report. BJOG: Inter J Obstet Gynaecol. 1986;93(1):82-3.

Descamps V, Aitken J, Lee MG. Hippocrates on necrotising fasciitis. The Lancet. 1994;344(8921):556.

McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558-65.

Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2)279-88.

Park SY, Moon SY, Son JS, Lee MS. Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report. J Korean Med Sci. 2011;26(1):131-4.

Majeski J, Majeski E. Necrotizing fasciitis: improved survival with early recognition by tissue biopsy and aggressive surgical treatment. Southern Med J. 1997;90(11):1065-8.

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(8):1454-60.

Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. Inter J Dermatol. 2007;46(10):1036-41.

Almarzouqi F, Grieb G, Klink C, Bauerschlag D, Fuchs PC, Alharbi Z, et al. Fatal necrotizing fasciitis following episiotomy. Case Rep Surg. 2015;2015:562810.

Jiao L, Chagla Z, Kaki RM, Gohla G, Smieja M. Case report of necrotizing fasciitis associated with streptococcus pneumoniae. Can J Infect Dis Med Microbiol. 2016;2016:6872739.

Medhi R, Rai S, Das A, Ahmed M, Das B. Necrotizing fasciitis - a rare complication following common obstetric operative procedures: report of two cases. Int J Womens Health. 2015;7:357-60.