An unusual case report on necrotising fascitis following episiotomy

Abstract

Necrotizing fasciitis is a rare but serious condition with high morbidity and mortality. It is identified by extensive fascial necrosis with relative sparing of the skin and adjacent muscle. Herein, we report a case of 35-year-old, para 2 living 2, who underwent normal vaginal delivery with dextrolateral episiotomy, and was discharged on post-natal day-4 asymptomatic. She was referred to our centre, on post-natal day 9 with excruciating pain and abnormal discharge from episiotomy site, after initiation of broad-spectrum antibiotics. Upon arrival, routine thorough clinical examination done revealed extensive sloughing of tissue at the episiotomy site. Laboratory work up were done, along with which infective markers were also sent. After routine pre-op work up, patient was taken up for emergency surgical debridement. Multi-staged debridement was done during the subsequent days, until healthy granulation tissue was seen. Pus and wound culture were sent, and culture sensitive antibiotics were continued. Post-operatively, patient was continued on antibiotics, sitz bath given and regular wound dressing done for next 5 weeks. She was discharged on post-op day 34. On 12 months follow up, patient was completely asymptomatic, examination revealed a completely healed vulva with minimal disfigurement.