Ono Ryohei, Kashiwagi Hiroyuki, Kawachi Jun, Isogai Naoko, Miyake Katsunori, Murata Takaaki, Shimoyama Rai, Fukai Ryuta, Ogino Hidemitsu, Shinozaki Nobuaki
Department of Surgery, Shonan Kamakura General Hospital, Japan.
Department of Surgery, Shonan Kamakura General Hospital, Japan.
Int J Surg Case Rep. 2018;49:121-125. doi: 10.1016/j.ijscr.2018.06.028. Epub 2018 Jun 30.
Liver gas gangrene is rare and has a low prognosis. This case, reports a successful treatment of hepatic gas gangrene using an open drainage technique, followed by antibiotics and hyperbaric oxygen therapy (HBO).
An 82-year-old male with a history of left hepatectomy and bile duct resection for hilar cholangiocarcinoma presented with chilling, lethargy and dyspnea. He had a history of diabetes mellitus, hypertension, atrial fibrillation, and angina pectoris. Physical examination revealed scleric icterus, right hypochondrium tenderness and percussion tenderness of the liver, with warm extremities. Laboratory findings revealed leukocytosis and increased levels of hepatobiliary enzymes. A computed tomography (CT) scan showed gas accumulation in an S8 lesion with portal vein gas. Percutaneous drainage was performed immediately, and broad-spectrum antibiotics were started, but the drainage was insufficient. Consequently, laparotomy drainage was carried out, followed by HBO. No abscess was detected at one-year of follow-up.
Hepatic gas gangrene progresses rapidly and has a high mortality rate. Malignant disease and diabetes mellitus may be predisposing factors. While half of non-clostridial cases survive, most cases of hepatic gas gangrene are associated with clostridial infection and have a fatal outcome.
All survival cases of hepatic gas gangrene were treated by laparotomy drainage, thus immediate laparotomy seems essential to prevent a fatal outcome.
肝气性坏疽罕见且预后较差。本病例报告了采用开放引流技术，随后联合使用抗生素和高压氧治疗（HBO）成功治疗肝气性坏疽的情况。
一名82岁男性，有因肝门胆管癌行左肝切除术和胆管切除术史，出现寒战、嗜睡和呼吸困难。他有糖尿病、高血压、心房颤动和心绞痛病史。体格检查发现巩膜黄疸、右季肋部压痛及肝脏叩击痛，四肢温暖。实验室检查发现白细胞增多及肝胆酶水平升高。计算机断层扫描（CT）显示S8段病变有气体积聚及门静脉积气。立即进行经皮引流，并开始使用广谱抗生素，但引流不充分。因此，进行了剖腹探查引流，随后进行高压氧治疗。随访一年未发现脓肿。
肝气性坏疽进展迅速，死亡率高。恶性疾病和糖尿病可能是诱发因素。虽然非梭菌性病例中有一半存活，但大多数肝气性坏疽病例与梭菌感染有关，且预后不良。
所有肝气性坏疽存活病例均接受了剖腹探查引流治疗，因此立即进行剖腹手术似乎是预防致命后果的关键。
