Thoracoabdominal necrotising soft tissue infection secondary to enterocutaneous fistulae

A case report

R. L. Lassiter, E. L. Simmerman, J. Sol Oh, C. J. Mentzer, N. E. Burkart, Steven B Holsten

Research output: Contribution to journalArticle

Abstract

Objective: Necrotising soft tissue infection is a rare surgical emergency, which requires immediate and aggressive surgical debridement. Following control of the infection, patients are often left with large defects, with wound reconstruction and closure creating significant challenges. Here we describe a case of extensive thoracoabdominal necrotising soft tissue infection and provide a discussion on the standard of care and treatment based on a current literature review. Method: A 53-year-old female presented with bilious and feculent discharge from her surgical incision two weeks after a total abdominal hysterectomy. She was found to have two enterocutaneous fistulae and an extensive abdominal wall necrotising soft tissue infection extending to the lower thorax. Wide excision and debridement were performed, leaving a large triangular defect. Following serial washouts and debridements, a biologic mesh with openings for the enterocutaneous fistulae was used to cover the fascial defect Results: Postoperatively, the patient was discharged to a nursing facility where she remained on total parenteral nutrition due to high fistula output. She subsequently underwent fistulectomy nine months later followed by skin grafting. To date, she has not had any recurrent fistulae or infection. Conclusion: Necrotising soft tissue infection resulting in a large abdominal wall defect secondary to enterocutaneous fistulae poses a significant challenge for source control and abdominal wall reconstruction. After serial debridements, use of biologic mesh for temporary closure followed by staged resection of the bowel with abdominal wall reconstruction can be performed. Declaration of interest: The authors have no personal financial or institutional interest in any of the drugs, materials, or devices used.

Original languageEnglish (US)
Pages (from-to)S4-S7
JournalJournal of Wound Care
Volume25
DOIs
StatePublished - Oct 1 2016

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Intestinal Fistula
Soft Tissue Infections
Abdominal Wall
Debridement
Fistula
Skin Transplantation
Total Parenteral Nutrition
Standard of Care
Infection Control
Hysterectomy
Nursing
Emergencies
Thorax
Equipment and Supplies
Wounds and Injuries
Infection
Pharmaceutical Preparations

Keywords

  • Abdominal wall reconstruction
  • Biologic
  • Enterocutaneous fistula
  • Necrotising soft tissue infection

ASJC Scopus subject areas

  • Fundamentals and skills
  • Nursing (miscellaneous)

Cite this

Thoracoabdominal necrotising soft tissue infection secondary to enterocutaneous fistulae : A case report. / Lassiter, R. L.; Simmerman, E. L.; Oh, J. Sol; Mentzer, C. J.; Burkart, N. E.; Holsten, Steven B.

In: Journal of Wound Care, Vol. 25, 01.10.2016, p. S4-S7.

Research output: Contribution to journalArticle

Lassiter, R. L. ; Simmerman, E. L. ; Oh, J. Sol ; Mentzer, C. J. ; Burkart, N. E. ; Holsten, Steven B. / Thoracoabdominal necrotising soft tissue infection secondary to enterocutaneous fistulae : A case report. In: Journal of Wound Care. 2016 ; Vol. 25. pp. S4-S7.
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