Miller Aaron T, Byrn John C, Divino Celia M, Weber Kaare J
Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Am Surg. 2007 Sep;73(9):876-9.
We report an unusual case of necrotizing fasciitis in a 43-year-old man after elective inguinal hernia repair. The patient presented to the emergency department 9 days postoperatively with high fevers, tachycardia, and crepitus along his abdominal wall. He was treated with broad-spectrum antibiotics and underwent a diagnostic laparoscopy as well as a wide debridement of all necrotic tissue. Cultures grew out Eikenella corrodens, which, to our knowledge, has only been reported in one other case as a cause of necrotizing fasciitis. Patients can develop necrotizing fasciitis after elective, clean procedures and should be adequately resuscitated, undergo immediate surgical debridement, and receive antibiotics. Laparoscopy can be useful in determining if intraabdominal pathology is the cause of the infection and a wound vacuum-assisted device is a cost-effective way to decrease healing times.
我们报告了一例43岁男性在择期腹股沟疝修补术后发生坏死性筋膜炎的罕见病例。患者术后9天因高热、心动过速和腹壁捻发音就诊于急诊科。他接受了广谱抗生素治疗,并接受了诊断性腹腔镜检查以及对所有坏死组织的广泛清创术。培养结果显示为腐蚀艾肯菌,据我们所知,此前仅有另一例报告该菌作为坏死性筋膜炎的病因。患者在择期清洁手术后也可能发生坏死性筋膜炎,应进行充分的复苏,立即接受手术清创,并使用抗生素。腹腔镜检查有助于确定腹腔内病变是否为感染原因,伤口负压辅助装置是缩短愈合时间的一种经济有效的方法。