Abdominal Wall Infected Ischemic Necrosis Mimicking Necrotizing Fasciitis

Emergency surgery to revascularize an ischemic leg in the presence of an aortic aneurysm presents a series of difficult management decisions in both the operative and postoperative phases. We present a case of infected ischemic necrosis that developed in a discrete tissue plane from a transverse incision mimicking necrotizing fasciitis. A 57-year-old man presented with an ischemic leg associated with a 5-cm abdominal aortic aneurysm. The sudden appearance of gangrenous tissue in the inferior flap of the transverse abdominal incision prompted urgent surgical debridement. This case report describes the management of a potentially misleading clinical condition. The key points to remember are to maintain a high index of suspicion for potentially life-threatening soft tissue infections, to be vigilant about regular wound inspection, and to act decisively when urgent wound debridement is indicated.