Multifocal necrotizing fasciitis following Hirshsprung’s disease surgery away from the surgical wound site

Abstract

Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF. NF typically arises in a single area usually secondary to penetrating injury. NF was only reported as a postoperative complication of Hirshsprung’s disease in one report, where the causative agent was Pseudomonas aeruginosa. We here present a case of synchronous multifocal NF in a 7-month Hirshsprung’s disease patient after abdominal Soave procedure. The patient presented with constipation and had a colosotomy undergone at the splenic flexure through a left transverse supraumbilical incision during neonatal period. At the age of 7 months and after preoperative preparation, abdominal Soave procedure was performed through a Pfannestiel incision. Few days following operation he had fever, tachycardia, and pain. Local examination showed red edematous areas at both flanks away from the wounds. Shortly afterwards skin became dark, tense, and started to slough. At this stage the clinical diagnosis of NF was raised and surgical debridement was done. Blood and tissue cultures were positive for E. coli. Five days later the patient had another debridement due to necrotic wound edges. Vacuum assisted closure therapy with Aquacel Ag dressings was fitted and changed every 48 h. Eighteen days later split thickness skin-graft was carried out. The patient was discharged home; 10 days later he is doing fine on follow-up.

Keywords: complication of swave procedure, Hirshsprung’s disease, necrotizing fasciitis