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A 30-year-old female patient presented to casualty with a 3-week history of left groin and abdominal pain, general malaise and fever. Of note, she was 18 weeks pregnant and had a history of intravenous drug abuse.On clinical examination, the patient was in septic shock and her abdomen was globally tender with guarding. There was no palpable hernia or mass with in the groin, however, she had bilateral dry sinuses in the femoral triangles and raised haematological infection markers.The initial abdominal radiograph (figure 1) showed gas over the region of the left groin. Radiographs of the left hip, including a lateral (figure 2), revealed a fluid level above the hip joint with gas superiorly.This raised the concern of underlying suppurative infection and an urgent CT scan was arranged (figure 3). This demonstrated an extensive retroperitoneal collection extending from the origin of the psoas to the left hip and changes within the left femoral head.An emergency operation was performed where copious pus and necrotic tissue were debrided from the left hip, groin and lower abdomen. The left femoral head was necrotic, which required a Girdlestone’s procedure (figure 4). After several further operations and a prolonged spell in the intensive therapy unit, the patient is making a good recovery.There are multiple complications arising from parental drug use, some of which have severe consequences and are often diagnostically challenging.1 Diseases of the skin and soft tissues are the most common causes of hospital admission with complications including thrombosis, septic arthritis and necrotising fasciitis.2
Footnotes
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Competing interests None.
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Patient consent Obtained.