Introduction: Necrotizing fascitis (flesh-eating disease) is an insidiously advancing soft tissue infection characterized by widespread fascial necrosis. It was first described in 1848. The causative bacteria may be aerobic, anaerobic, or mixed flora, and the expected clinical course varies from patient to patient. The 3 most important types of necrotizing fasciitis syndromes are type I (polymicrobial); type II (group A streptococcal); and type III gas gangrene (clostridial myonecrosis). The mean age of the patients is 38–44 years. The male-tofemale ratio is 3:1. Necrotizing fasciitis can be difficult to recognize in their early stages, but they rapidly progress. They require aggressive treatment to combat the associated high morbidity and mortality (which is in overall 70–80%). Material and Methods: A 24 year old female presented with 3 months history of right loinpain following labour, Intravenous pyelogram showed Right sided hydronephroureter due to ureteric stone. Extracorporeal Shock Wave Lithotripsy session was performed for the patient. One day later, she started to develop severe abdominal pain different from the previous one. Results: On examination she got tenderness and feeling of crepitus in the wall of the right side of the abdominal wall, which was not present previously, CT scan revealed Right abdominal wall necrotizing fasciitis, extending to the retroperitoneum, Diagnostic Laparoscopy confirm the diagnosis. We treated her by repeated aggressive wound excision, antibiotics and treatment was completed by skin graft. Conclusions: This case not only represent a concurrence of an unusual entity but also alerts us that necrotizing fasciitis may developed after Extracorporeal Shock Wave Lithotripsy. A retroperitoneal nidus of infection may be considered. Early diagnosis, aggressive and emergent surgical intervention are required for the survival of these patients

ESWL for ureteric stone: unusual cause of necrotizing fasciitis in previously healthy young female

Introduction: Necrotizing fascitis (flesh-eating disease) is an insidiously advancing soft tissue infection characterized by widespread fascial necrosis. It was first described in 1848. The causative bacteria may be aerobic, anaerobic, or mixed flora, and the expected clinical course varies from patient to patient. The 3 most important types of necrotizing fasciitis syndromes are type I (polymicrobial); type II (group A streptococcal); and type III gas gangrene (clostridial myonecrosis). The mean age of the patients is 38–44 years. The male-tofemale ratio is 3:1. Necrotizing fasciitis can be difficult to recognize in their early stages, but they rapidly progress. They require aggressive treatment to combat the associated high morbidity and mortality (which is in overall 70–80%). Material and Methods: A 24 year old female presented with 3 months history of right loinpain following labour, Intravenous pyelogram showed Right sided hydronephroureter due to ureteric stone. Extracorporeal Shock Wave Lithotripsy session was performed for the patient. One day later, she started to develop severe abdominal pain different from the previous one. Results: On examination she got tenderness and feeling of crepitus in the wall of the right side of the abdominal wall, which was not present previously, CT scan revealed Right abdominal wall necrotizing fasciitis, extending to the retroperitoneum, Diagnostic Laparoscopy confirm the diagnosis. We treated her by repeated aggressive wound excision, antibiotics and treatment was completed by skin graft. Conclusions: This case not only represent a concurrence of an unusual entity but also alerts us that necrotizing fasciitis may developed after Extracorporeal Shock Wave Lithotripsy. A retroperitoneal nidus of infection may be considered. Early diagnosis, aggressive and emergent surgical intervention are required for the survival of these patients