A case of necrotizing fasciitis developing after cesarean section

Abstract

Necrotizing fasciitis (NF) is a rare condition that is observed in obstetric and gynecological practices. It is a rapidly progressive and often fatal complication. Failure to obtain an early diagnosis and delay in initiating appropriate treatment can lead to significant morbidity and mortality. Our case was 25 years old, and she was in her first pregnancy. The patient had no systemic disease or history of previous surgery. Our patient’s baby was delivered by cesarean section with an indication of emergency fetal distress. During the cesarean section, it was observed that the amniotic fluid contained  very dark meconium. No complications occurred during the cesarean section. Our patient presented with complaints of severe pain, bullae, and hyperemia at the level of the incision line one week later. In her vital findings, fever was 39.3 ºC, blood pressure was 90/60 mmHg, and heart rate was 110 /min. In laboratory tests, white blood cell count was 25,280 /mm3, C-reactive protein (CRP) was 431 mg/dL, and sedimentation was 100 mm/hour. On the ultrasonographic examination, air, significant edema, and thickening were observed in the incision line, skin, and subcutaneous tissues. On the computed tomography scan, thickening of the skin and subcutaneous tissues, fluid locations, and areas of air densities were observed over a wide area extending to the level of the thoracic 10th and 11th vertebrae superiorly and to the mons pubis inferiorly. Based on  these findings, the patient was diagnosed with NF. After broad-spectrum antibiotic therapy and fluid-electrolyte support, extensive surgical debridement was performed under emergency conditions. Before applying the skin graft, vacuum-assisted wound closure was performed, and a very good response was obtained. The patient, whose pathology result was compatible with necrotizing fasciitis, was discharged on the 20th post-operative day. In this case, we aimed to present a case of NF after cesarean section.