Ghidirim Gh, Gagauz I, Mişin Ig, Guţu E, Vozian M
Clinica Chirurgie nr. 1 N. Anestiadi şi Laboratorul Chirurgie Hepato-Pancreato-Biliară, Universitatea de Stat de Medicină si Farmacie N.Testemitanu, Spitalul Clinic Municipal de Urgenţă, Chişinău, Moldova.
Chirurgia (Bucur). 2005 May-Jun;100(3):293-6.
The authors present an additional case of emphysematous necrotizing pancreatitis caused by Escherichia coli. Emphysematous necrotizing pancreatitis represents a rare and potentially life-threatening infection and is characterized by gas formation within or around the pancreas. A 26-year-old man presented with severe upper abdominal pain and vomiting, 7 hours from onset. Acute pancreatitis was initially diagnosed based on high amylase level, abdominal ultrasonography and primary CT scan. On the 7th day he developed fever, increasing abdominal pain and shortness of breath. On the second abdominal CT scan, the pancreatic bed was filled with gas. The diagnosis of emphysematous necrotizing pancreatitis was confirmed at laparotomy. The patient was treated successfully by extensive pancreatic necrosectomy, open packing and scheduled repeated debridements. Culture from the lesser sac, and retroperitoneal space, examined for aerobes and anaerobes, revealed growth of Escherichia coli. The authors analyze and discuss pathogenesis, diagnosis and treatment of emphysematous necrotizing pancreatitis. Based on the available data and this case, early surgical debridement and appropriate antibiotics appear to be the preferred treatment.
作者报告了另一例由大肠杆菌引起的气肿性坏死性胰腺炎病例。气肿性坏死性胰腺炎是一种罕见且可能危及生命的感染，其特征是胰腺内部或周围形成气体。一名26岁男性在发病7小时后出现严重上腹痛和呕吐。最初根据高淀粉酶水平、腹部超声和初次CT扫描诊断为急性胰腺炎。第7天，他出现发热、腹痛加剧和呼吸急促。在第二次腹部CT扫描中，胰腺床充满气体。剖腹手术证实了气肿性坏死性胰腺炎的诊断。患者通过广泛的胰腺坏死组织清除术、开放填塞和定期重复清创成功治愈。从小网膜囊和腹膜后间隙培养的需氧菌和厌氧菌检查显示有大肠杆菌生长。作者分析并讨论了气肿性坏死性胰腺炎的发病机制、诊断和治疗。根据现有数据和该病例，早期手术清创和适当的抗生素似乎是首选治疗方法。
