Teo Joshua, Silva Munasinghe T, Van Rooyen Henk
Surgery, Queensland Health, Brisbane, AUS.
Surgery, Queensland Health, Hervey Bay, AUS.
Cureus. 2021 Sep 28;13(9):e18347. doi: 10.7759/cureus.18347. eCollection 2021 Sep.
A 39-year-old female presented to a regional Australian hospital with diabetic ketoacidosis. Urine microscopy, culture and sensitivity (MCS) on arrival revealed 500 leukocytes and eventually culture grew pansensitive E. coli. Patient was transferred to ICU for ongoing care where she remained tachycardic despite resolution of her diabetic ketoacidosis. A CT pulmonary angiogram was performed which found a right lower lobe pulmonary embolus for which therapeutic anticoagulation was commenced. However, tachycardia persisted and the patient became febrile on day three of admission. A CT abdomen pelvis was performed which revealed left-sided emphysematous pyelonephritis secondary to a large staghorn calculus. Significant subcutaneous emphysema was also found in the left flank. A general surgery review was requested and the case was discussed with the urology team located at a tertiary centre. The patient was subsequently transferred to a tertiary hospital under urology where she underwent a left nephrectomy and wound debridement. This was complicated by colonic perforation and was repaired with an omental patch with a loop ileostomy formed. Patient underwent a total of six relooks and debridements before the wound was closed with a combination of delayed primary closure and split-thickness skin graft.
一名39岁女性因糖尿病酮症酸中毒被送往澳大利亚一家地区医院。入院时尿液显微镜检查、培养及药敏试验（MCS）显示有500个白细胞，最终培养出对所有药物敏感的大肠杆菌。患者被转至重症监护病房接受持续治疗，尽管糖尿病酮症酸中毒已得到缓解，但她仍心动过速。进行了CT肺动脉造影，发现右下叶肺栓塞，遂开始进行治疗性抗凝。然而，心动过速持续存在，患者在入院第三天发热。进行了CT腹部盆腔扫描，结果显示左侧气肿性肾盂肾炎继发于一个大的鹿角形结石。左侧胁腹也发现了明显的皮下气肿。请求普通外科会诊，并与位于三级中心的泌尿外科团队讨论了该病例。患者随后被转至一家三级医院的泌尿外科，在那里接受了左肾切除术和伤口清创术。手术出现结肠穿孔并发症，用网膜补片修复，并形成了回肠袢造口术。患者在伤口通过延迟一期缝合和中厚皮片移植相结合的方式闭合之前，总共接受了六次复查和清创。
