Ludwig's angina complicated with a massive necrotizing fasciitis caused by an unusual pathogen: Bacillius spp

Ludwig's angina and necrotizing fasciitis are aggressive infectious manifestations that can present in the cervicofacial region. The severity of these entities depends, up to some extent, to the immunological state of the patient. Diabetes mellitus alters the immune system, allowing maxillofacial infections to progress aggressively. Bacillius spp. is a group of typically innocuous bacteria; however, they can unchain relevant infectious pathologies in immunocompromised patients. The purpose of this study is to describe a case of an uncontrolled diabetic patient with a Ludwig's angina which progressed to a massive necrotizing fasciitis caused by bacillius spp. Explaining the severity of this class of infections and the special attention that should be paid to this type of case; Furthermore, when the culture reveals pathogens that are usually not involved in the development of this class of conditions.

[Necrotizing fasciitis of the abdominal wall secondary to a perforated sigmoid diverticulum in a Spiegel's hernia. A case report]. / Fascitis necrotizante de pared abdominal secundaria a diverticulitis sigmoidea perforada en una hernia de Spiegel. Reporte de un caso.

It is uncommon that a complicated diverticular disease presents as an extraperitoneal manifestation, and it is also rare for diverticulitis to be the cause of a necrotizing fasciitis. Necrotizing fasciitis (NF) of the abdominal wall is not common and has a high mortality rate. We present a patient with NF of the abdominal wall secondary to a perforated colon diverticulum in a Spiegel's hernia without peritonitis or intraabdominal abscess. The absence of peritoneal manifestations delayed early diagnosis, which was evident through crepitation of the abdominal wall. Computed tomography (CT) revealed a severe inflammatory process characterized by the presence of gas in the abdominal wall. The patient underwent emergency surgery with debridement of all necrotic tissue, exploratory laparotomy, sigmoidectomy and derivative colostomy, but due to her advanced age and multiple organ failure, the outcome was fatal.

Helical computed tomographic angiography for the diagnosis of traumatic arterial injuries of the extremities.

BACKGROUND: The radiologic study of choice for evaluation of traumatic arterial injuries is conventional arteriography, but it poses the risks of an invasive procedure. Computed tomographic arteriography (CTA) is emerging as a new way to study arterial anatomy, with the additional advantages of being noninvasive and a technique that allows evaluation of different body areas simultaneously. Our experience using CTA for evaluation of traumatic arterial injuries is provided in this study. METHODS: A retrospective review over a 22-month period of all adult patients undergoing CTA for evaluation of traumatic injuries to the extremities was performed. RESULTS: A total of 97 CTA studies were performed in the 95 patients. CTA adequately demonstrated the nature and location of all the arterial injuries when compared with conventional arteriography or surgical exploration. Abnormal CTA results included 21 arterial occlusions, 2 intimal flap defects, and 2 pseudoaneurysms. Nine of these 25 injuries were confirmed by surgery only, 10 by surgery and arteriography, and 6 by arteriography only. Normal CTA results were confirmed with arteriography in 10 cases. No missed injuries were encountered in patients with normal CTA results. CONCLUSION: CTA is a reliable technique for the detection and characterization of traumatic extremity arterial injuries. These results suggest CTA may be an alternative to conventional arteriography for the diagnosis of traumatic arterial injuries.