Ichisawa Aika, Jin Hiroyuki, Hagiwara Yusuke, Hara Yutaro, Kimura Toshiro, Yonaiyama Shinnosuke, Yoshikawa Toru, Nakai Makoto, Tokura Tomohisa, Aoki Kazunori, Kawashima Hiroaki, Toyoki Yoshikazu, Endoh Masaaki
Dept. of Surgery, Aomori City Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2574-2576.
A 70-year-old woman was brought to our hospital by ambulance because of severe groin pain on the right side. Computed tomography scan revealed a tumor in the ascending colon, intraperitoneal abscess spread to the subcutaneous tissues, and a large amount of pneumoderma. She was diagnosed with necrotizing fasciitis caused by penetration of ascending colon cancer and underwent lavage and drainage, right hemicolectomy, end ileostomy, and debridement of necrotic tissues on emergency. Postoperatively, she underwent debridement and irrigation at the bedside every day, but the necrotizing tissues spread. Debridement under general anesthesia was repeated on postoperative day 8. On postoperative day 20, negative pressure wound therapy(NPWT)was initiated to manage the exudates and wound condition, and healthy granulation tissues formed gradually. After 4 weeks, she underwent split-thickness skin graft implantation. The postoperative course was uneventful, and she was discharged from the hospital. She is currently on chemotherapy and has been alive for 1 year and 3 months after the first operation.
一名70岁女性因右侧腹股沟剧痛被救护车送至我院。计算机断层扫描显示升结肠有肿瘤，腹腔脓肿蔓延至皮下组织，并有大量皮下气肿。她被诊断为升结肠癌穿透导致的坏死性筋膜炎，并在急诊时接受了冲洗引流、右半结肠切除术、末端回肠造口术以及坏死组织清创术。术后，她每天在床边进行清创和冲洗，但坏死组织仍在扩散。术后第8天在全身麻醉下再次进行清创。术后第20天，开始采用负压伤口治疗（NPWT）来处理渗出物和伤口情况，健康的肉芽组织逐渐形成。4周后，她接受了中厚皮片移植术。术后过程顺利，她出院了。她目前正在接受化疗，首次手术后已存活1年零3个月。
