Necrotising fasciitis (NF) is a subset of aggressive skin and soft tissue infections that cause necrosis of the muscle fascia and subcutaneous tissue. NF is relatively rare, with an estimated annual incidence of NF of 0.5–10 cases per 100,000 people worldwide. This infection typically travels along the fascial plane, which has a poor blood supply, leaving the overlying tissues initially unaffected, potentially delaying diagnosis and surgical intervention [1, 2]. The infectious process can rapidly spread, causing infection of the fascia and peri-fascial planes, and leading to a secondary infection of the overlying and underlying skin, soft tissue, and muscle [3, 4]. Although it can occur in any region of the body, the abdominal wall, perineum, and extremities are the most common sites of infection. Involvement of the abdominal wall is usually a postoperative complication of abdominal surgery [1]. Elevated inflammatory biomarkers are standard features of NF patients. In one series, all instances of postoperative necrotising fasciitis occurred after contaminated or clean-contaminated surgery, mainly in patients with extensive faecal contamination of the abdominal cavity [1, 4–7].

A 35-year-old male was admitted to the hospital with the diagnosis of calculous cholecystitis. In accompanying examinations in the patient’s medical file, the abdominal ultrasound showed a gallbladder with thickened walls containing stones. Laboratory tests revealed WBC 9.68 × 10³ K/µl, haemoglobin 15.8 g/dl, total bilirubin 0.5 mg/dl, alanine aminotransferase (ALT) 51 U/l, and aspartate aminotransferase (AST) 20 U/l. The patient had no other accompanying diseases and did not report any history of alcohol, drug, or tobacco use. In these conditions, an uncomplicated laparoscopic cholecystectomy was performed. During the procedure, significant inflammation of the gallbladder was noted, along with numerous adhesions between the gallbladder and surrounding structures, particularly the duodenum. A closed suction drain was placed in the subhepatic space due to minor intraoperative oozing. The first 24-hour post-operative course following intervention was satisfactory. The next day, the patient experienced several episodes of fever, and a subcutaneous phlegmon (2–3 cm) was observed around the abdominal drain, which gradually evolved into cellulitis, rapidly spreading laterally and posteriorly...


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