Takazawa Tomonori, Ohta Jou, Horiuchi Tatsuo, Hinohara Hiroshi, Kunimoto Fumio, Saito Shigeru
Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
Department of Intensive Care, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
BMC Res Notes. 2016 Aug 3;9:385. doi: 10.1186/s13104-016-2194-0.
Gas gangrene is a necrotic infection of soft tissue associated with high mortality rates. We report a case of postoperative gas gangrene with very acute onset and rapid progression of symptoms. To our knowledge, this case is the most acute onset of postoperative gas gangrene ever reported.
A 65-year-old Japanese female patient developed a shock state 16 h after radical cystectomy with ileal conduit reconstruction. Two days after the operation, she was transferred to the intensive care unit because of deterioration in her respiratory and circulatory condition. Soon after moving her to the ICU, a subcutaneous hemorrhage-like skin rash appeared and extended rapidly over her left side. Blood tests performed on admission to the ICU indicated severe metabolic acidosis, liver and renal dysfunction, and signs of disseminated intravascular coagulation. Suspecting necrotizing fasciitis or gas gangrene, we performed emergency fasciotomy. Subsequently, multidisciplinary treatment, including empirical therapy using multiple antibiotics, mechanical ventilation, hyperbaric oxygen therapy, polymyxin B-immobilized fiber column direct hemoperfusion, and continuous hemodiafiltration, was commenced. Culture of the debris from a wound abscess removed by emergency fasciotomy detected the presence of Clostridium perfringens. We hypothesized that the source of infection in this case may have been the ileum used for bladder reconstruction. Although the initial treatment prevented further clinical deterioration, she developed secondary infection from the 3rd week onward, due to infection with multiple pathogenic bacteria. Despite prompt diagnosis and intensive therapy, the patient died 38 days after the operation.
Although the patient did not have any specific risk factors for postsurgical infection, she developed a shock state only 16 h after surgery due to gas gangrene. Our experience highlights the fact that physicians should be aware that any patient could possibly develop gas gangrene postoperatively.
气性坏疽是一种软组织坏死性感染，死亡率很高。我们报告一例术后气性坏疽病例，其起病非常急，症状进展迅速。据我们所知，该病例是有史以来报告的术后气性坏疽最急性起病的病例。
一名65岁的日本女性患者在根治性膀胱切除术后行回肠代膀胱术重建术后16小时出现休克状态。术后两天，由于呼吸和循环状况恶化，她被转入重症监护病房。转到重症监护病房后不久，她左侧出现了类似皮下出血的皮疹，并迅速蔓延。入住重症监护病房时进行的血液检查显示严重代谢性酸中毒、肝肾功能障碍以及弥散性血管内凝血迹象。怀疑为坏死性筋膜炎或气性坏疽，我们进行了紧急筋膜切开术。随后，开始了多学科治疗，包括使用多种抗生素的经验性治疗、机械通气、高压氧治疗、多粘菌素B固定纤维柱直接血液灌流以及持续血液透析滤过。紧急筋膜切开术清除的伤口脓肿碎片培养检测到产气荚膜梭菌。我们推测该病例的感染源可能是用于膀胱重建的回肠。尽管初始治疗防止了临床状况进一步恶化，但从第3周起她因多种病原菌感染而发生继发感染。尽管诊断及时且治疗积极，但患者术后38天死亡。
尽管该患者没有任何术后感染的特定危险因素，但她术后仅16小时就因气性坏疽出现休克状态。我们的经验凸显了医生应意识到任何患者术后都有可能发生气性坏疽这一事实。
