Sato Kentaro, Yamamura Hitoshi, Sakamoto Yoshiyuki, Morohashi Hajime, Miura Takuya, Yoshikawa Toru, Suto Akiko, Tsuruta Satoru, Hakamada Kenichi
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Department of Disaster and Critical Care Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
Surg Case Rep. 2018 Nov 26;4(1):136. doi: 10.1186/s40792-018-0544-y.
Necrotizing fasciitis (NF) caused by colorectal cancer is rare, and very few cases associated with colon cancer have been reported. We describe the case of a patient with NF in the left thigh due to penetration of descending colon cancer who was treated with one-stage surgical resection without creating a stoma.
An 80-year-old woman was brought to our hospital complaining of fever and difficulty with body movement. A physical examination showed subcutaneous emphysema from the left lower abdomen to the left femoral region. CT showed abscess formation with emphysema around the descending colon, and the wall of the descending colon was thickened, which led to suspicion of colon cancer. The patient was subsequently diagnosed with NF due to penetration of descending colon cancer. Left hemicolectomy and open drainage of the left femoral region was performed. The histopathological findings were well-differentiated adenocarcinoma, with the tumor grown through the serosa (T4a) and with no metastasis to lymph nodes (N0). After surgery, the patient received intensive care for septic shock and lavage of the open drainage site, and sepsis was controlled progressively. After closure of the drainage site, the patient was transferred to a different hospital at 26 days after surgery, and she has had 6-month relapse-free survival.
In NF caused by colon cancer, early one-stage resection may improve the oncological outcome. Physical status should be assessed carefully, and one-stage resection should be considered if the patient has the capacity to undergo this procedure.
结直肠癌引起的坏死性筋膜炎（NF）较为罕见，仅有极少数与结肠癌相关的病例报道。我们描述了一例因降结肠癌穿孔导致左大腿坏死性筋膜炎的患者，该患者接受了一期手术切除且未造口。
一名80岁女性因发热和身体活动困难被送至我院。体格检查发现从左下腹至左大腿区域有皮下气肿。CT显示降结肠周围有脓肿形成并伴有气肿，降结肠壁增厚，这引发了对结肠癌的怀疑。该患者随后被诊断为因降结肠癌穿孔导致的坏死性筋膜炎。进行了左半结肠切除术及左大腿区域的开放引流。组织病理学检查结果为高分化腺癌，肿瘤穿透浆膜（T4a），无淋巴结转移（N0）。术后，患者因感染性休克接受了重症监护及开放引流部位的灌洗，感染逐渐得到控制。引流部位闭合后，患者于术后26天转至另一家医院，目前已无瘤生存6个月。
在结肠癌引起的坏死性筋膜炎中，早期一期切除可能改善肿瘤学结局。应仔细评估患者身体状况，若患者有能力接受该手术，则应考虑一期切除。
