1. Radiological Findings

Based on the provided CT transverse and sagittal images, the main observation is significant abnormal changes in the abdominal wall and subcutaneous tissues. These changes manifest as low-density areas within the subcutaneous layer and deep fascial spaces, with some regions showing gas density (presenting as small black bubble-like appearances), suggesting the possible presence of gas in the tissues or fascial layers. Certain areas of the abdominal wall soft tissue are thickened, with localized inflammatory changes. Additionally, assessments of bowel loops and other visible intra-abdominal organs do not indicate suspicious masses or hemorrhages, and the position and distribution of abdominal contents do not appear notably abnormal.

2. Possible Diagnoses

Considering the patient is a 59-year-old female with sudden acute abdominal pain, and the imaging shows gas densities in the subcutaneous and deep fascial regions of the abdominal wall, the following possible diagnoses should be considered:

1. Necrotizing Fasciitis: Characterized by gas formation in the fascial and subcutaneous layers and rapid soft tissue destruction, commonly seen in immunocompromised or diabetic patients. The presence of gas within the deep fascial spaces and the extensive spread of inflammation strongly suggests this condition.
2. Cellulitis with Gas Formation: Severe cellulitis caused by specific pathogens can also result in gas production in the subcutaneous or deeper soft tissues, though the degree of fascial damage is usually less severe than in necrotizing fasciitis.
3. Gas Gangrene: Caused by gas-producing bacteria such as Clostridium perfringens, often with rapid progression and the presence of large amounts of gas in the tissues. It is commonly associated with open trauma or postoperative infections. Further differentiation would require detailed patient history and clinical presentation.

3. Final Diagnosis

Taking into account the patient’s history (e.g., possible diabetes, immunocompromised status), clinical manifestations (acute abdominal pain, abdominal wall tenderness, or systemic malaise), radiological findings (gas in the deep fascial and subcutaneous tissues, wide-ranging inflammatory spread), and intraoperative findings (necrotic tissue in the abdominal wall) during emergency surgery, the most likely final diagnosis is Necrotizing Fasciitis. For further verification of the pathogen, tissue culture, bacteriological testing, or other laboratory investigations (such as white blood cell count, CRP, and PCT) can be performed.

4. Treatment Plan and Rehabilitation Program

Treatment Strategy:

• Surgical Intervention: Necrotizing fasciitis is a severe infection requiring urgent treatment. Early and thorough debridement to remove necrotic tissue is crucial for controlling the infection.
• Antibiotic Therapy: Broad-spectrum antibiotics effective against Gram-negative, Gram-positive, and anaerobic bacteria should be used. Adjustments can be made based on pathogen identification.
• Supportive Care: Includes fluid replacement, nutritional support, maintenance of acid-base and electrolyte balance, and symptomatic treatment (pain management, fever control, etc.).
• Blood Glucose Management: In patients with comorbid diabetes, controlling blood glucose levels is essential to enhance the body’s resistance to infection.

Rehabilitation and Exercise Prescription (FITT-VP Principle):

• Initial Phase (Acute Recovery):
  • After debridement and anti-infective treatment, start with basic bed exercises and deep breathing exercises to prevent pulmonary complications.
  • Practice these 3-5 times daily, at very low intensity for short durations (about 5-10 minutes each time), focusing on restoring circulatory and respiratory function.
• Transitional Phase (Gradual Recovery):
  • Once the infection is under control, the wound is stable, and the patient’s physical condition shows improvement, introduce mild out-of-bed activities and joint mobility exercises under professional guidance.
  • Engage in these activities 3-5 times weekly, for about 15-20 minutes each session, at low to moderate intensity (e.g., slow walking, basic muscle strengthening). Gradually increase exercise volume based on tolerance.
• Long-Term Phase (Functional Rehabilitation):
  • As physical capacity permits, progressively incorporate moderate-intensity exercises, such as brisk walking or light resistance training to strengthen muscle and cardiovascular function.
  • Perform these 3-5 times weekly, for 20-30 minutes each session. Adjust intensity according to cardiorespiratory tolerance.
• Precautions:
  • Closely monitor vital signs (blood glucose, blood pressure, heart rate) if the patient has diabetes or other chronic conditions.
  • Take good care of the wound, ensuring proper hygiene to avoid traction or pressure injuries.
  • Seek immediate medical evaluation if any discomfort arises (e.g., fever, worsening pain, or increased redness/swelling of the skin).

Disclaimer: This report provides reference analysis only and should not be regarded as the final basis for diagnosis and treatment. Specific treatment plans must be determined by a professional medical team after comprehensive evaluation of the patient’s actual condition. For any inquiries, please consult a specialist or visit a reputable medical institution.