Pouriki S, Skalistir M, Zoumpouli C, Alexakis N
Intensive Care Unit, Hippocratio NHS Hospital , Athens , Greece.
Department of Anesthesiology, Hippocratio NHS Hospital , Athens , Greece.
Ann R Coll Surg Engl. 2017 Nov;99(8):e223-e224. doi: 10.1308/rcsann.2017.0138. Epub 2017 Sep 15.
An 82-year-old man presented with abdominal pain and a painful and swollen left thigh. On examination there was oedema, tenderness and crepitus with skin discoloration of the left thigh. Computed tomography showed retroperitoneal perforation of the caecum and necrotising fasciitis of the left thigh. A right hemicolectomy and repeated fasciotomies of the left thigh with debridement of necrotic tissue were performed but the patient died of multi-organ failure. Histology showed a pT4aN2c caecal adenocarcinoma. This is a unique presentation of a retroperitoneal caecal perforation and acts as a reminder that unexplained severe fasciitis of the thigh may be caused by an intra-abdominal pathology.
一名82岁男性因腹痛及左大腿疼痛肿胀就诊。检查发现左大腿有水肿、压痛、捻发音及皮肤变色。计算机断层扫描显示盲肠腹膜后穿孔及左大腿坏死性筋膜炎。患者接受了右半结肠切除术及左大腿反复筋膜切开术并清创坏死组织，但最终死于多器官功能衰竭。组织学检查显示为pT4aN2c期盲肠腺癌。这是一例腹膜后盲肠穿孔的独特表现，提醒我们大腿不明原因的严重筋膜炎可能由腹腔内病变引起。
