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Challenges in trauma and acute care surgery
Necrotizing fasciitis following abdominal gunshot wound
  1. Eliza Moskowitz1,2,
  2. Thomas Schroeppel1
  1. 1Department of Surgery, Memorial Hospital, Colorado Springs, Colorado, USA
  2. 2Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Eliza Moskowitz, Department of Surgery, Memorial Hospital, Colorado Springs CO 80045, USA; eliza.moskowitz{at}ucdenver.edu

https://doi.org/10.1136/tsaco-2018-000163

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    A 39-year-old man presented to our hospital as a trauma activation following multiple gunshot wounds to the abdomen. He was taken to the operating room (OR) where abdominal exploration revealed multiple small and large intestinal injuries. The injured segments of the distal small bowel and proximal colon were resected and bowel continuity was restored. Additionally, a smaller sigmoid colon injury near the level of the sacral promontory was identified and primarily repaired. The multiple missile sites were not aggressively debrided, but were irrigated and left to close by secondary intent. Perioperative antibiotics were continued for 24 hours given intra-abdominal contamination. The patient continued his recovery in the surgical intensive care unit (SICU). On postoperative day (POD) 2, he remained hypotensive despite vasopressor support and began to clinically deteriorate. As such, he was taken back to the OR for re-exploration. Intact anastomoses and colorrhaphy were appreciated.

    On POD 10 from his initial laparotomy, he developed cellulitis and an abdominal wall abscess. He was taken to the OR for incision and …

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