An unwonted case of Meleney’s like abdominal wall necrotizing soft tissue infection

Abstract

Poly-microbial infection leading to necrotizing soft tissue infection is known to cause fulminant sepsis resulting in significant mortality and morbidity despite aggressive medical and surgical management. We present a case of Meleney’s like synergistic gangrene of abdominal wall culminating in full blown sepsis and death in the background of penetrating injury to the abdomen. Our patient was a 36 year old female, who presented with a penetrating injury to the abdomen due to a road traffic accident resulting in a laceration over the anterior abdominal wall with evisceration of bowel and omentum. After initial resuscitation, patient was immediately taken up for exploration and multiple small bowel perforations were primarily repaired. Postoperatively, she developed severe polymicrobial infection at the laceration site which extended all over the abdomen. She was treated with broad spectrum antibiotics based on culture and sensitivity and serial debridement of necrosis was done. She developed ventral hernia during the course, which was complicated by necrosis of bowel which was managed by resection and anastomosis. Postoperatively, she developed multi-organ dysfunction due to sepsis and succumbed to infection. We imply on the necessity of innovative techniques and multidisciplinary approach for controlling sepsis and compensating the significant soft tissue loss due to widespread necrotizing infection.