Thoracoabdominal necrotising soft tissue infection secondary to enterocutaneous fistulae: a case report

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.

Keywords: abdominal wall reconstruction; biologic; enterocutaneous fistula; necrotising soft tissue infection.