Abdominal wall necrotizing fasciitis as a complication of strangulated hernia - an ominous consequence of a preventable scenario

The incidence rate of abdominal wall necrotizing fasciitis (NF) is low; however, it carries a high mortality rate. It can arise as a complication of a strangulated hernia, where a part of the intestine becomes trapped and deprived of its blood supply. Rarely, this can result in abdominal wall fasciitis, which carries a grim prognosis. Timely debridement, however, has been shown to yield improved outcomes. Here, we report our experience with a 53-y-old morbidly obese patient who presented with colicky abdominal pain lasting for 1 week, progressively worsening and becoming constant. She also exhibited symptoms of fever, constipation, vomiting and anorexia. Furthermore, there was an infected wound measuring 20 cm × 13 cm along the midline of the abdomen. Imaging studies revealed indications of small bowel obstruction. This case describes a unique presentation of strangulated incisional hernia complicated by NF of the anterior abdominal wall, successfully managed with surgery.