Necrotizing fasciitis post Cesarean
From: RModugno@aol.com
Fri Sep 23 14:36:42 2005
Recent scary case:
19 year old Black primigravida, weight 190 lbs ,GBS negative, had C/S in
labor for breech. No history of diabetes.
Benign post -partum course.
Presents to ER 12 days post-partum with foul-smelling "dishwater discharge"
from left lateral end of wound and edema of the left abdominal wall up to
axilla.
CT Scan reveals - normal post cesarean uterus and adnexa with gas in the
anterior abdominal wall consistent with clinical fiidings
First thought: call general surgeon!
Seen by general surgeon(trained at Charity, NOLA!).
Wound "fileted" in OR - necrotizing fasciitis. Hockey stick incisionn over
section wound and up left side. to left rib cage. Wound debrided. Has had third
debriding in OR- now has wound vac in place and tissue looking pink. I think
we have turned the corner! I'm holding my breath.
Cultures: mixed aerobes anerobes, staph, strep.
Dealt with plenty of wound infections in South Africa and in the USA, but
nothing like this.
Robert Modugno MD MBA FACOG
Marietta, GA
