Okada Ken-ichi, Shatari Tomoo, Yamamoto Tatsuma, Sasaki Takahiro, Suwa Tatsushi, Furuuchi Takayuki, Takenaka Yoshifumi, Hori Masao, Sakuma Masayoshi
Department of Surgery, Mito Red Cross Hospital, Sannomaru, Mito, Ibaraki 310-0011, Japan.
J Hepatobiliary Pancreat Surg. 2007;14(3):336-9. doi: 10.1007/s00534-006-1185-2. Epub 2007 May 29.
We present an unusual case of necrotizing fasciitis in the upper abdominal wall caused by penetrating perforation of the gallbladder. It was manifested as an elastic and reddish abdominal swelling with severe tenderness, but no peritoneal irritation. Computed tomography (CT) demonstrated water density with a slightly elevated CT value and air bubbles in the subcutaneous space. The preoperative diagnosis was subcutaneous abscess with fasciitis. At surgery, necrotizing fasciitis and subcutaneous abscess secondary to penetrating perforation of the gallbladder were revealed. Cholecystectomy and peritoneal irrigation were performed. Although no tumor was evident during surgery, a tumor located close to the perforation site was found just after the operation. Pathological examination revealed gallbladder carcinoma without stones. There have been very few previous reports of necrotizing fasciitis following gallbladder perforation. The presentation, diagnosis, and management of fasciitis, as well as carcinoma of the gallbladder with perforation, are discussed.
我们报告一例由胆囊穿透性穿孔引起的上腹壁坏死性筋膜炎的罕见病例。其表现为上腹部有弹性的红肿肿胀，压痛明显，但无腹膜刺激征。计算机断层扫描（CT）显示皮下间隙呈水样密度，CT值略有升高且有气泡。术前诊断为皮下脓肿伴筋膜炎。手术中发现为胆囊穿透性穿孔继发坏死性筋膜炎和皮下脓肿。行胆囊切除术及腹腔冲洗。虽然术中未发现明显肿瘤，但术后立即发现一个靠近穿孔部位的肿瘤。病理检查显示为无结石的胆囊癌。既往关于胆囊穿孔后发生坏死性筋膜炎的报道极少。本文讨论了筋膜炎以及穿孔性胆囊癌的临床表现、诊断和治疗。
