Necrotizing fasciitis after abdominal trauma: A case report

A case of a lower extremity necrotizing fasciitis (NF) in a young patient operated for liver trauma, having no visible skin wounds, discussed and correlated to the present literature. The patient was admitted to the Hospital after a road traffic accident (RTA). From the Past Medical History (PMH) he referred a history of lymphoma which was successfully treated. Initially he was diagnosed with a liver rupture and no other concomitant injuries. He was operated and admitted to the Intensive Care Unit (ICU). An abscess complicated the initial operation which was promptly drained. He then developed skin necrosis of the right lower extremity. During the operation the muscles looked viable. The skin, subcutaneous fat and fasciae were extensively necrotized. Lhrinec score was 8 and cultures showed fungal development. Necrotizing fasciitis (NF) was the most probable diagnosis. After having successive operations on the leg, the NF was disseminated and the patient died. Necrotizing fasciitis is rare in young patients with no predisposing factors, such as Diabetes Mellitus, active cancer and renal disease. In the present case the successive operations, massive blood transfusion and possibly the history of a Lymphoma could have played a role in this rare and frequently fatal condition.