Lee James C, Bringmann Ingra, Aly Ahmad
Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia.
Int J Surg Case Rep. 2012;3(4):137-8. doi: 10.1016/j.ijscr.2011.08.018. Epub 2011 Nov 22.
We present a patient with an unusual combination of surgical findings, complicated by both a medical condition and the treatment there of.
A 52 year-old man with Wegener's granulomatosis presented with groin pain and sepsis while on immunosuppressive therapy. Large retroperitoneal abscesses were found on CT scanning, together with a collapsed left lower lobe of the lung, a complete infarct of the spleen, and evidence of diverticulosis. At the exploratory laparotomy, the infarcted spleen was removed and the retroperitoneal abscesses were drained via a separate lateral incision. Uncomplicated diverticular disease were also confirmed.
The left lower lobe collapse, infarcted spleen and diverticular disease were all potential sources of the sepsis, but none of them could be clearly linked to the abscesses. The splenic infarct and a post-operative myocardial infarct were likely related to his vasculitic disease.
Patients with systemic vasculitis may present with unusual pathologies, and immunosuppressive treatment may also modify clinical presentation.
我们报告一例患者，其手术所见组合异常，同时合并一种内科疾病及其治疗相关情况。
一名52岁患有韦格纳肉芽肿病的男性在接受免疫抑制治疗期间出现腹股沟疼痛和脓毒症。CT扫描发现巨大的腹膜后脓肿，同时左肺下叶萎陷、脾脏完全梗死以及存在憩室病迹象。在剖腹探查术中，切除梗死的脾脏，并通过单独的外侧切口引流腹膜后脓肿。还证实存在无并发症的憩室病。
左肺下叶萎陷、脾脏梗死和憩室病均可能是脓毒症的潜在来源，但它们均无法明确与脓肿相关联。脾脏梗死和术后心肌梗死可能与他的血管炎疾病有关。
系统性血管炎患者可能出现不寻常的病理情况，免疫抑制治疗也可能改变临床表现。
