Gietzmann William Kristian Miles, Mousinho Joana, Tandon Karuna, Turner Samuel
East Sussex Hospitals NHS Trust, Eastbourne, East Sussex, UK.
BMJ Case Rep. 2014 Jun 18;2014:bcr2014203809. doi: 10.1136/bcr-2014-203809.
A 23-year-old glazer presented to the A&E department with pain in his left arm following a 2 mm puncture injury to his left thenar eminence. Examination showed crepitus throughout the arm and over the chest wall. Plain X-rays confirmed extensive surgical emphysema but no evidence of pneumothorax. Clinical observations and laboratory markers for infection were normal. The patient was prescribed broad spectrum antibiotics for presumed gas-producing organism infection. After 24 h cultures returned negative and no other signs of infection were detected. Treatment was discontinued and the patient was allowed home. Several days later he experienced severe diarrhoea and as a result required time off work. No cause was found on investigation. We postulate a benign aetiology for the surgical emphysema in this case. In future it may be possible to recognise benign surgical emphysema at presentation and avoid prescribing unnecessary antibiotics.
一名23岁的玻璃安装工因左手鱼际隆起处被2毫米的刺伤，导致左臂疼痛，前往急症室就诊。检查发现整个手臂及胸壁均有捻发音。X线平片证实有广泛的手术性气肿，但无气胸迹象。临床观察及感染的实验室指标均正常。考虑到可能是产气菌感染，给该患者开了广谱抗生素。24小时后培养结果为阴性，未发现其他感染迹象。停止治疗，让患者回家。几天后，他出现严重腹泻，因此需要休假。调查未发现病因。我们推测该病例中手术性气肿的病因是良性的。未来或许有可能在就诊时识别出良性手术性气肿，避免开具不必要的抗生素。
