A 29-year-old heroin addict presented with a 2-week history of right neck swelling preceded by a dental infection. He was diagnosed with necrotizing fasciitis of the neck. He underwent urgent tracheostomy, incision and drainage, and debridement of necrotic tissue. Over the following 70 days, he experienced multiple complications including bleeding, sepsis, ventilator dependence, and organ failure. Despite extensive medical and surgical interventions, his condition deteriorated and he died on day 70.

1. Mortality due to
Neck Necrotizing
Fasciitis
RES/ MAHMOUD AL SAEED

2.  Male patient 29 years old
 Heroin addict otherwise medically free
 Surgically free
 Presented by Right neck swelling of 2 weeks
duration preceded by dental infection

4.  Mild Trismus
 Edema in floor of the mouth
 TLC: 50 000
 HB: 6.5
 CT Neck and Chest:

6. Operative Details:
 Urgent Tracheostomy
 Incision and Drainage
 Debridement of necrotic tissue
 Insertion of corrugated drain
 Received 3 units of packed RBCs
Patient was then transferred to ICU

7. From Day 1 to Day 10:
 Patient was fully conscious on mechanical
ventilator
 Patient was on Levo 20 and Adrenaline 20
 Cardio-Thoracic consultation was done,
insertion of chest tube bilaterally
 TLC: 50 000 (on admission) – 40 000
 HB: 9.0
 Gastrostomy was done

9. From Day 11 to Day 20:
 Patient was fully conscious
 Off Levo and Adrenaline
 Off Ventilator
 During routine dressing, active bleeding occurred,
patient arrested, CPR was done and the patient
responded after 2 cycles
 Then the patient underwent exploration and
ligation of superior thyroid artery was done
 Patient received 2 units of packed RBCs

10. From Day 21 to Day 30:
 Patient was fully conscious
 On mechanical ventilator
 On Levo 10 and Adrenaline 5
 TLC: 35 000 – 25 000
 Patient complained of abdominal pain for which
abdominal U/S was done showing moderate pelvic
collection and surgical consultation was done
 Patient underwent abdominal exploration revealing
leakage from gastrostomy
 Closure of leakage site and removal of gastrostomy and
feeding jejunostomy was inserted

11. From Day 31 to Day 40:
 Patient was fully conscious
 On Levo 10 and Adrenaline 5
 On mechanical ventilator
 TLC: 30 000
 Removal of chest tubes bilaterally
 Patient underwent insertion of 3 corrugated
drains under GA

14.  TLC: 12 000
 Off Levo and Adrenaline
 Off Ventilator

15. From Day 41 to Day 70:
 Patient complained off abdominal pain for
which abdominal U/S was done revealed
moderate pelvic collection
 Surgical consultation was done and patient
underwent abdominal exploration which
revealed leakage from jejunostomy
 Closure of leakage site was done then the
patient returned to ICU

16.  Patient was comatosed
 On mechanical ventilator
 On Levo 20 and Adrenaline 20
 TLC: 45 000
 Creatinine: 5.2
 Urea: 373

17.  PH: 6.9
 PCO2: 25
 HCO3: 9.0
 Patient underwent 3 sessions of hemodialysis
 At day 70 patient arrested and died.