Cellulitis and necrotizing fasciitis of the abdominal wall in pediatric patients.

Soft tissue infections of the abdominal wall in 14 children were classified as cellulitis (8), necrotizing fasciitis (5), or myositis/myonecrosis (1). These 3 categories were characterized by increasing anatomic depth of infection, clinical severity, and need for more radical surgical treatment. Ten of the 14 children were neonates. The most frequent associations were omphalitis (5), necrotizing enterocolitis (4), and urachal anomalies (3). The severest infections were usually polymicrobial and contained both aerobic and anaerobic bacteria. Important clinical findings in children with necrotizing fasciitis and myositis/myonecrosis were tachycardia, systemic toxicity, severe edema, and, in older children, pain out of proportion to the apparent degree of infection. None of the children had fever or crepitation of the wound. An ominous sign, indicative of the need for immediate, radical debridement was the appearance of a patch of dusky or gangrenous skin. There were two deaths associated with delayed diagnosis of necrotizing fasciitis. One child did not receive radical debridement, and the other received it too late to be of benefit. Although these infections are rare in children, their lethal potential and early diagnostic signs must be recognized.