Sütçü Murat, Duran Şık Güntulu, Gün Feryal, Somer Ayper, Salman Nuran
Department of Pediatric Infectious Diseases, İstanbul University İstanbul Faculty of Medicine, İstanbul-Turkey.
Department of Pediatric Intensive Care, İstanbul University Istanbul Faculty of Medicine, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2016 Sep;22(5):505-508. doi: 10.5505/tjtes.2015.45675.
Necrotizing fasciitis is a life-threatening soft tissue infection characterized by progressive necrosis of the skin, subcutaneous tissues and fascia. Fournier's gangrene (FG) is a serious and aggressive form of infective necrotizing fasciitis involving perineal region and genitalia. Presently described are 2 pediatric cases of FG with widespread necrosis of surrounding tissue following anorectal surgery, causing severe septic shock. Case 1: Six-month-old female patient with anal stenosis and duplication presented at emergency clinic with fever, somnolence, irritability, and feeding difficulty. Physical examination upon admission to Intensive Care Unit (ICU) with septic shock determined she had ecchymosis in anal region. At 12fth hour after admission, lesion had become necrotic and patient was started on broad-spectrum antibiotics after surgical debridement. Cultures were negative and patient had complete recovery 2 months after admission. Case 2: Nine-month-old male patient was admitted to ICU for convulsions and sepsis eight hours after fistulectomy. Scrotal, gluteal, and perianal edema and ecchymosis were observed on physical examination. Perianal debridement and colostomy were performed, and patient was given broad-spectrum antibiotics after basic life support strategies for septic shock. Complete recovery was achieved after hyperbaric oxygen treatment for perianal lesion and patient was discharged from the hospital in third month after admission. After anorectal surgery, every patient should be observed carefully for FG. Early debridement, proper antibiotics, and hyperbaric oxygen treatment can be life-saving.
坏死性筋膜炎是一种危及生命的软组织感染，其特征为皮肤、皮下组织和筋膜进行性坏死。福尼尔坏疽（FG）是感染性坏死性筋膜炎的一种严重且侵袭性的形式，累及会阴区域和生殖器。本文报告了2例小儿FG病例，均在肛门直肠手术后出现周围组织广泛坏死，导致严重感染性休克。病例1：一名6个月大的女性患者，患有肛门狭窄和重复畸形，因发热、嗜睡、烦躁和喂养困难到急诊就诊。因感染性休克入住重症监护病房（ICU）时的体格检查发现她肛门区域有瘀斑。入院后第12小时，病变已坏死，手术清创后开始使用广谱抗生素。培养结果为阴性，患者入院2个月后完全康复。病例2：一名9个月大的男性患者在肛瘘切除术后8小时因惊厥和败血症入住ICU。体格检查发现阴囊、臀部和肛周水肿及瘀斑。进行了肛周清创和结肠造口术，并在对感染性休克采取基本生命支持措施后给予患者广谱抗生素。肛周病变经高压氧治疗后完全康复，患者入院后第3个月出院。肛门直肠手术后，应对每位患者仔细观察是否发生FG。早期清创、适当使用抗生素和高压氧治疗可挽救生命。
