Luglio Gaetano, Amendola Alfonso, Pagano Gianluca, Tropeano Francesca Paola, Errico Chiara, Esposito Enrica, Palomba Giuseppe, Dinuzzi Paola, De Simone Giuseppe, De Palma Giovanni Domenico
Department of Public Health. University of Naples "Federico II", Naples, Italy.
Ann Med Surg (Lond). 2020 Jul 15;57:123-126. doi: 10.1016/j.amsu.2020.06.037. eCollection 2020 Sep.
We report the case of a successful management with combined aggressive surgery and negative pressure therapy, to treat a severely ill-septic patient, affected by multiple chronic enterocutaneous fistulas.
A 26-year-old female patient presented with multiple pelvic and intra-abdominal abscesses, enterocutaneous fistulas and central venous catheter-related bacteraemia in extremely poor general conditions.The patient underwent both an abdominal CT which showed multiple digestive loops stuck and apparently fistulised and an abdominal-pelvic MRI, confirming the CT findings, and demonstrating a third fistula involving the Pouch and responsible for a pelvic and retroperitoneal chronic abscess.Given the patient's septic condition, despite several attempts of conservative therapies, an aggressive surgical approach was adopted.After temporary abdominal wall closure, the patient underwent Vacuum Assisted Closure therapy in order to close the abdominal wall and drain the residual abscess. The patient was discharged at the 35th post-operative day in good general conditions.
This case is about a complex, long-lasting clinical scenario, progressively leading a young woman to death despite several attempts of conservative therapy, sometimes allowed to treat enterocutaneous fistulas. The use of negative pressure therapy to manage open abdomen is still controversial. Patients affected by enterocutaneous fistulas are in need of adequate nutritional support due to their hypercatabolic state, secondary both to the fluid loss and the concomitant inflammatory status.
When conservative management fails and the patient shows septic complications, a multidisciplinary aggressive approach, including surgery, negative-pressure therapy and hyperbaric oxygen therapy is required to treat this life-threatening condition.
我们报告了一例通过联合积极手术和负压疗法成功治疗一名患有多处慢性肠皮肤瘘的重症脓毒症患者的病例。
一名26岁女性患者，全身状况极差，出现多处盆腔和腹腔脓肿、肠皮肤瘘以及中心静脉导管相关菌血症。患者接受了腹部CT检查，显示多个消化袢粘连且明显存在瘘管，还进行了腹盆腔MRI检查，证实了CT检查结果，并显示出第三个瘘管累及储袋，导致盆腔和腹膜后慢性脓肿。鉴于患者的脓毒症状况，尽管多次尝试保守治疗，仍采用了积极的手术方法。在临时关闭腹壁后，患者接受了真空辅助闭合疗法，以闭合腹壁并引流残余脓肿。患者在术后第35天出院，全身状况良好。
该病例是一个复杂、持久的临床情况，尽管多次尝试保守治疗，有时甚至是针对肠皮肤瘘的治疗，但仍逐渐导致一名年轻女性死亡。使用负压疗法治疗开放性腹部仍存在争议。由于肠皮肤瘘患者处于高分解代谢状态，继发于液体丢失和伴随的炎症状态，他们需要充足的营养支持。
当保守治疗失败且患者出现脓毒症并发症时，需要采取多学科积极方法，包括手术、负压疗法和高压氧疗法来治疗这种危及生命的疾病。
