Necrotizing cellulitis of the abdominal wall, caused by Pediococcus sp., due to rupture of a retroperitoneal stromal cell tumor.

Jan 2013

Michalopoulos N, Arampatzi S, Papavramidis TS, Kotidis E, Laskou S, Papavramidis ST.

Source

3rd Department of Surgery, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece. Electronic address: nickos.michalopoulos@gmail.com.

Abstract

INTRODUCTION:

Soft tissue necrotizing infections are a significant cause of morbidity and mortality. The aim of this study is to present a patient with necrotizing infection of abdominal wall resulting from the rupture of a retroperitoneal stromal tumor.

PRESENTATION OF CASE:

We present a 60-year-old Caucasian male patient with necrotizing infection of abdominal wall secondary to the rupture of a retroperitoneal stromal tumor. The patient was initially treated with debridement and fasciotomy of the anterior abdominal wall. Laparotomy revealed purulent peritonitis caused by infiltration and rupture of the splenic flexure by the tumor. Despite prompt intervention the patient died 19 days later. The isolated microorganism causing the infection was the rarely identified as cause of infections in humans Pediococcus sp., a gram-positive, catalase-negative coccus.

DISCUSSION:

Necrotizing infections of abdominal wall are usually secondary either to perineal or to intra-abdominal infections. Gastrointestinal stromal cell tumors could be rarely complicated with perforation and abscess formation. In our case, the infiltrated by the extra-gastrointestinal stromal cell tumor ruptured colon was the source of the infection. The pediococci are rarely isolated as the cause of severe septicemia.

CONCLUSION:

Ruptured retroperitoneal stromal cell tumors are extremely rare cause of necrotizing fasciitis, and before this case, Pediococcus sp. has never been isolated as the responsible agent.

PubMed

Sonography first for subcutaneous abscess and cellulitis evaluation.

Sonography first for subcutaneous abscess and cellulitis evaluation.

Oct 2012

1. Srikar Adhikari, MD, RDMS and 
2. Michael Blaivas, MD

1. Author Affiliations

   1. Department of Emergency Medicine, University of Arizona Medical School, Tucson, Arizona USA (S.A.); and Department of Emergency Medicine, Northside Hospital Forsyth, Cumming, Georgia USA (M.B.).

   1. Address correspondence to Michael Blaivas, MD, Department of Emergency Medicine, Northside Hospital Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30040-1147 USA. E-mail:mike@blaivas.org
   Sonography is an ideal imaging modality for evaluation of pathologic soft tissue conditions. High resolution and the ability to perform dynamic testing such as compressing structures allow for accurate differentiation between potentially confusing physical findings. Traditionally, clinicians assumed that any area of the skin that was erythematous and showed swelling potentially harbored an abscess. Incision and drainage has long been the standard of care in such cases and was often used as a diagnostic procedure. However, studies have confirmed anecdotal clinical evidence that the physical examination is often incorrect. In fact, not only was incision and drainage being performed unnecessarily, in some cases, needed procedures were missed after failure to recognize the presence of an abscess. With the recent spread of sonography into clinical practice, multiple descriptions of point-of-care sonography use in suspected soft tissue infections have been published. Some have even noted that blind incision and drainage, once thought to be harmless, could lead to serious potential complications because not all red swollen structures should be cut with a scalpel. This article reviews clinical scenarios in which point-of-care soft tissue sonography is useful in suspected skin infections and describes pathologic findings and commonly accepted scanning approaches.
   Journal of Ultrasound