Survival after retroperitoneal necrotizing fasciitis

✍ Scribed by T. Mokoena; A. P. Jayatunga

• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 130 KB
• Volume: 81
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800810544

✦ Synopsis

Survival after retroperitoneal necrotizing fasditis

Sir

It was interesting to read the Case Report by Mr Jayatunga and colleagues (Br J Surg 1993; 80: 981). It is remarkable that their elderly diabetic patient had such a successful outcome following limited dehridement, and antibiotic and supportive therapy, without further debridement. Our experience', which is shared by others', suggests that necrotizing fasciitis. especially in the retroperitoneum, is an aggressive condition that usually spreads relentlessly even after apparently sufficient initial debridement and demands equally aggressive surgical management. This requirement implies radical excision of necrotic tissue and re-examination under anaesthesia together with repeat debridement. Using the latter approach we found spreading necrosis in more than half of our patients on 'second look' laparotomy, and still experienced two deaths among ten relatively young patients. We therefore suggest a cautious response to the success reported in this particular case and the inference that lesser surgical procedures could be cntertained as a guide to management of necrotizing fasciitis.