Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.
Appendicitis* ; Bacterial Infections ; Dermis ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Mortality ; Thigh

Necrotizing fasciitis has been recognized as a potentially lethal and rapidly progressing infection. Necrotizing fasciitis of head and neck area is rare but fatal disease that should be prompt diagnosis and recognition. If not promptly recognized and treated, infection can spread into the deep spaces of the neck and compromise the airway. It may also spread into the mediastimum producing life threatening sepsis. In this report, we describe the treatment of 4 cases of necrotizing fasciitis of head and neck area and discuss diagnosis, treatment, complication and consideration with review of literatures.
Anti-Bacterial Agents ; Diagnosis ; Fasciitis, Necrotizing* ; Head* ; Neck* ; Sepsis

Fournier's gangrene is a life-threatening disorder characterized by necrotizing fasciitis of the perineal region. Because delay in diagnosis and treatment of this condition can be fatal, it is important not to overlook the symptoms. We present an unusual case of Fournier's gangrene after excision of a thrombosed hemorrhoid. A previously healthy 74-year-old female patient developed Fournier's gangrene after a hemorrhoidectomy. In spite of aggressive treatment, she eventually died. Here, we emphasize early recognition and prompt treatment of this condition, reporting an unexpected disastrous complication of a hemorrhoidectomy.
Aged ; Diagnosis ; Fasciitis, Necrotizing ; Female ; Fournier Gangrene* ; Hemorrhoidectomy ; Hemorrhoids* ; Humans

Necrotizing fasciitis is an uncommon infection of the subcutaneous soft tissue and fascia. The infection is expands rapidly and is highly lethal, so an early diagnosis and a radical debridement of all affected tissues until healthy tissue is encountered is imperative. There are many diagnostic methods such as simple X-ray study, ultrsonography, computerized tomography and diagnostic multiple incisions, but nothing can disclose the extent of affected tissue definitely. Recently someone advocated that magnetic resonance imaging(MRI) is useful to diagnose necrotizing fasciitis. We could determine the extent of underlying infection in a patient with perineal necrotizing fasciitis by using preoperative MRI, and treat it by one surgical resection. We propose that MRI can be used to diagnose the necrotizing fasciitis early and to disclose the extent of affected tissue, to help determine the extent of resection.
Debridement ; Early Diagnosis* ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Magnetic Resonance Imaging*

Humans ; Fasciitis, Necrotizing/diagnosis* ; Prospective Studies ; Organ Dysfunction Scores ; Prognosis

Necrotizing fasciitis is rare acute infection showing rapidly necrosis involve the subcutaneous tissue and fascia. If treatment is delayed, infection can spread to involve the subcutaneous tissue, skin, deep fascia, and even muscle in rapid sequence, resulting in widespread necrosis and moderate to severe systemic toxicity. Most commonly this disease presents in the extremities, trunk, and perineum; it is relatively rare in the head and neck regions. If not diagnosed and treated in its early stages, necrotizing fasciitis can be potentially fatal, with a motality rate approaching 40%. Historically, the clinical entity now referred to as necrotizing fasciitis was described in the literature under various name. : hospital gangrene, necrotizing erysipelas, streptococcal gangrene, suppurative fasciitis. Necrotizing fasciitis was first described by Wilson in 1952. We experienced 3 cases of necrotizing fasciitis and will report review of literature with diagnosis, treatment, complication and consideration.
Diagnosis ; Erysipelas ; Extremities ; Fascia ; Fasciitis ; Fasciitis, Necrotizing* ; Gangrene ; Head ; Neck ; Necrosis ; Perineum ; Skin ; Subcutaneous Tissue

Fasciitis, Necrotizing ; diagnosis ; Humans ; Intestinal Perforation ; diagnosis ; Rectal Diseases ; diagnosis ; Recurrence

Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures. It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis, and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge, this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.
Biopsy ; Ceftazidime ; Cephalosporins ; Debridement ; Diagnosis, Differential ; Fasciitis ; Fasciitis, Necrotizing ; Hydrazines ; Korea ; Osteitis ; Osteomyelitis ; Parturition ; Pregnancy ; Pseudomonas aeruginosa ; Pubic Symphysis ; Sports

Osteomyelitis of the pubic symphysis is not common and has often been reported to occur after urological or gynecological procedures. It can be spontaneous in origin but it also is associated with trauma, athletic exertion, pregnancy, and parturition. The early symptoms of osteomyelitis of the pubic symphysis mimic those of osteitis pubis, and therefore, the differential diagnosis between these two entities is of clinical importance. A fifty nine-year-old man who had previously received debridement and wide excision of perianal necrotizing fasciitis visited our hospital with pain on both inguinal areas. The core biopsy of the pubic symphysis and aspiration culture were performed, from which Pseudomonas aeruginosa was recovered. He was treated with parenteral ceftazidime for 5 days followed by cefepime for 7 weeks and showed favorable clinical response. To our knowledge, this is the first report on osteomyelitis of pubic symphysis resulting from debridement and wide excision of perianal necrotizing fasciitis in Korea.
Biopsy ; Ceftazidime ; Cephalosporins ; Debridement ; Diagnosis, Differential ; Fasciitis ; Fasciitis, Necrotizing ; Hydrazines ; Korea ; Osteitis ; Osteomyelitis ; Parturition ; Pregnancy ; Pseudomonas aeruginosa ; Pubic Symphysis ; Sports

Necrotizing fasciitis, first described by Wilson in 1952, is one of the most dramatic infectious diseases which develops at the level of superficial fascia and involves the overlying dermis. Clinical diagnosis is often initially confused with cellulitis, and delay in the diagnosis and treatment is associated with high mortality in the range from 30% to 70%. Early diagnosis and prompt excision of all devitalized tissue are critical because any remaining necrotic tissue will continue the rapidly progressive infectious process. We, herein, report a 64-year-old man who was presented with a typical clinical course of necrotizing fasciitis.
Cellulitis ; Communicable Diseases ; Dermis ; Diagnosis ; Early Diagnosis ; Fasciitis, Necrotizing* ; Humans ; Middle Aged ; Mortality ; Subcutaneous Tissue