Hair follicles, sweat and sebaceous glands of the vulval skin are common sites of infection and abscess formation. The contiguity of vulval fascial spaces with other anatomic compartments permits spread of infection from the vulva to the inner thigh, abdominal wall, or ischiorectal fossa.[1]
The differential diagnosis of a vulval abscess includes infectious and non-infectious vulval lesions. Among the infectious causes, vulvovaginitis presents mostly as erythema and less likely as asuppurative mass. Necrotising fasciitis though a rare condition may present as an abscess and should be suspected when the lesion is extensive with persistent pain, erythema, and induration.[2] Malignant lesions of the vulva may present as a firm lesion with surrounding …show more content…
The only history which was elicited was of itching and scratching over the left side of vulva few days prior to onset of symptoms. A close watch was kept for further extension of the abscess and development of necrotising fasciitis. But fortunately even though a large area was involved, necrosis and gangrene did not occur. Probably the parenteral antibiotics received in the private hospital prevented the causative organisms from growing and multiplying (as seen by negative pus culture report).
The decision of conventional incision and open drainage by the surgeons was made in view of the large extension of the abscess. In some cases closure by primary suturing may be done under antibiotic cover.[3]
She had preterm premature rupture of membranes probably due to some ascending infection that was not detected on cervical swab due to antibiotic use. Fortunately her abdominal wound healed well and she had no spread of sepsis as special care was taken to isolate her abscess site during the caesarean section. A midline vertical incision for caesarean section that was taken avoided the inevitable lateral extension into the infected left lower abdominal tissue planes.
This interesting case highlights the need of a multidisciplinary approach involving the general surgeons, and reconstructive plastic surgeons. Timely drainage and breaking of all loculi and regular dressing can bring out a favourable outcome even in a large vulval
The differential diagnosis of a vulval abscess includes infectious and non-infectious vulval lesions. Among the infectious causes, vulvovaginitis presents mostly as erythema and less likely as asuppurative mass. Necrotising fasciitis though a rare condition may present as an abscess and should be suspected when the lesion is extensive with persistent pain, erythema, and induration.[2] Malignant lesions of the vulva may present as a firm lesion with surrounding …show more content…
The only history which was elicited was of itching and scratching over the left side of vulva few days prior to onset of symptoms. A close watch was kept for further extension of the abscess and development of necrotising fasciitis. But fortunately even though a large area was involved, necrosis and gangrene did not occur. Probably the parenteral antibiotics received in the private hospital prevented the causative organisms from growing and multiplying (as seen by negative pus culture report).
The decision of conventional incision and open drainage by the surgeons was made in view of the large extension of the abscess. In some cases closure by primary suturing may be done under antibiotic cover.[3]
She had preterm premature rupture of membranes probably due to some ascending infection that was not detected on cervical swab due to antibiotic use. Fortunately her abdominal wound healed well and she had no spread of sepsis as special care was taken to isolate her abscess site during the caesarean section. A midline vertical incision for caesarean section that was taken avoided the inevitable lateral extension into the infected left lower abdominal tissue planes.
This interesting case highlights the need of a multidisciplinary approach involving the general surgeons, and reconstructive plastic surgeons. Timely drainage and breaking of all loculi and regular dressing can bring out a favourable outcome even in a large vulval