Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-29T04:41:11.392Z Has data issue: false hasContentIssue false

Case 17 - A 70-Year-Old Woman with Diabetes, Exquisitely Painful 2 cm Vulvar Ulcerative Lesion, and Subcutaneous Gas on CT Scan

Published online by Cambridge University Press:  19 November 2021

By
Courtney Rhoades
Edited by
Todd R. Jenkins ,
Lisa Keder ,
Abimola Famuyide ,
Kimberly S. Gecsi  and
David Chelmow
Todd R. Jenkins
Affiliation:
University of Alabama, Birmingham
Lisa Keder
Affiliation:
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Affiliation:
Mayo Clinic, Rochester
Kimberly S. Gecsi
Affiliation:
Medical College of Wisconsin
David Chelmow
Affiliation:
Virginia Commonwealth University School of Medicine
Get access

Summary

In the emergency room, a 70-year-old morbidly obese woman reports she has an ingrown hair on the right vulva. In the past day, it has grown dramatically in size. It is quite painful at rest and exquisitely painful with touch. She denies fever, nausea, or vomiting. Denies sexual activity in the past 10 years. Denies vaginal bleeding, discharge, and itching. Her past medical history is significant for diabetes for the past 40 years, hypertension, and urinary incontinence for which she wears pads. She states her blood sugar was in poor control in the past day or so. She does not smoke or have any other pertinent social history. Her medications include insulin and blood pressure medication. She denies a significant surgical history and had two term vaginal deliveries.

Keywords

necrotizing fascitisgangrenedebridement
Type
Chapter
Information
Surgical Gynecology
A Case-Based Approach
 , pp. 45 - 48
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Faro, S, Faro, JP Necrotizing soft-tissue infections in obstetric and gynecologic patients. Clin Obstet Gynecol 2012; 55: 875–87.CrossRefGoogle ScholarPubMed
Phan, HH, Cocanour, CS. Necrotizing soft tissue infections in the intensive care unit.Crit Care Med 2010; 38: S460–8.CrossRefGoogle ScholarPubMed
Wood, SC. Clinical manifestations and therapeutic management of vulvar cellulitis and abscess: methicillin-resistant Staphylococcus aureus, necrotizing fasciitis, Bartholin abscess, Crohn disease of the vulva, hidradenitis suppurativa. Clin Obstet Gynecol 2015; 58: 503–11.CrossRefGoogle ScholarPubMed
Fernando, SM, Tran, A, Cheng, W, et al. Necrotizing soft tissue infection: diagnostic accuracy of physical examination, imaging, and LRINEC score: a systematic review and meta-analysis. Ann Surg 2019; 269: 58–65.CrossRefGoogle Scholar
Wong, CH, Khin, LW, Heng, KS, et al. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004; 32: 1535–41.CrossRefGoogle Scholar
Laor, E, Palmer, LS, Tolia, BM, Reid, RE, Winter, HI. Outcome prediction in patients with Fournier’s gangrene. J Urol 1995; 154: 89–92.CrossRefGoogle ScholarPubMed
Stephenson, H, Dotters, DJ, Katz, V, Droegemueller, W. Necrotizing fasciitis of the vulva. Am J Obstet Gynecol 1992; 166: 1324–7.CrossRefGoogle ScholarPubMed
Yanaral, F, Balci, C, Ozgor, F, et al. Comparison of conventional dressings and vacuum assisted closure in the wound therapy of Fournier’s gangrene. Arch Ital Urol Androl 2017; 89: 208–11.CrossRefGoogle ScholarPubMed
Andreasen, TJ, Green, SD, Childers, BJ. Massive infectious soft-tissue injury: diagnosis and management of necrotizing fasciitis and purpura fulminans. Plast Reconstr Surg 2001; 107: 1025–35.CrossRefGoogle ScholarPubMed
Levett, D, Bennett, MH, Millar, I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database Syst Rev 2015; 1(1): CD007937.Google ScholarPubMed
Wong, CH, Wang, YS. The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 2005; 18: 101–6.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×