Lethal Necrotizing Cellulitis Caused by ESBL-Producing E. Coli after Laparoscopic Intestinal Vaginoplasty

J Pediatr Adolesc Gynecol. 2017 Feb;30(1):e19-e21. doi: 10.1016/j.jpag.2016.09.005. Epub 2016 Sep 21.

Abstract

Background: The absence of a functional vagina has a negative effect on the quality of life of women. Multiple surgical procedures have been described for vaginal reconstruction in these patients.

Case: We present a case of an 18-year-old transgender woman, who underwent laparoscopic intestinal vaginoplasty as vaginal reconstruction, and subsequently developed septic shock and multiple organ failure on the basis of an extended-spectrum β-lactamase-producing Escherichia coli. A severe progression of the necrotizing fasciitis was lethal, despite repeated surgical debridement, intravenous antibiotic use, and supportive care at the intensive care unit.

Summary and conclusion: Although vaginal reconstruction has a positive influence on the quality of life in transgender women, physicians and patients need to be aware of serious complications that might arise.

Keywords: Necrotizing fasciitis; Postoperative complications; Reconstructive surgical procedures; Vaginoplasty.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Cellulitis / microbiology*
  • Escherichia coli / enzymology*
  • Escherichia coli Infections / microbiology*
  • Fatal Outcome
  • Female
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods
  • Perineum / surgery
  • Plastic Surgery Procedures / adverse effects*
  • Plastic Surgery Procedures / methods
  • Postoperative Complications / microbiology*
  • Transgender Persons*
  • Vagina / surgery
  • beta-Lactamases / metabolism

Substances

  • beta-Lactamases