Lee Chien-Yu, Lee Yuarn-Jang, Chen Chia-Che, Kuo Li-Jen
Department of Pediatrics, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 32748, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan.
World J Clin Cases. 2021 Nov 26;9(33):10238-10243. doi: 10.12998/wjcc.v9.i33.10238.
Streptococcal toxic-shock syndrome after hemorrhoidectomy is rare but may be catastrophic. Group A streptococci have produced various surface proteins and exotoxins due to genetic changes to fight the human body's immune response. Though life threatening infection after hemorrhoidectomy rarely occurs, all surgeons should be aware of the potential complications of severe sepsis after hemorrhoidectomy and keep in mind their clinical presenting features in order to diagnose early and administer appropriate and effective therapeutic drugs early.
Here, we present a case of a 56-year-old man with a painful thrombotic external hemorrhoid who presented to our outpatient department for management. There was no history of systemic diseases or recent disease infection. Hemorrhoidectomy was suggested and performed. After surgery, the patient developed hypotension, tachycardia, fever with chills and renal function impairment on day 2 post-operation. The clinical condition progressed to severe septic shock and metabolic acidosis. The patient responded poorly to treatment and expired after 1 d even with use of extracorporeal membrane oxygenation. The results of the blood and wound cultures showed group A streptococcus pyogenes.
Although extremely uncommon, all surgeons should be aware of these potential life-threatening septic complications and alert to the presenting features for patients receiving hemorrhoidectomy.
痔切除术后链球菌中毒性休克综合征虽罕见，但可能是灾难性的。A 组链球菌由于基因变化产生了多种表面蛋白和外毒素，以对抗人体的免疫反应。尽管痔切除术后危及生命的感染很少发生，但所有外科医生都应意识到痔切除术后严重脓毒症的潜在并发症，并牢记其临床表现特征，以便早期诊断并尽早给予适当有效的治疗药物。
在此，我们报告一例 56 岁男性患者，因疼痛性血栓性外痔前来我院门诊就诊。患者无全身性疾病史或近期疾病感染史。建议并实施了痔切除术。术后第 2 天，患者出现低血压、心动过速、发热伴寒战及肾功能损害。临床病情进展为严重感染性休克和代谢性酸中毒。患者对治疗反应不佳，即使使用体外膜肺氧合，1 天后仍死亡。血液和伤口培养结果显示为 A 组化脓性链球菌。
尽管极为罕见，但所有外科医生都应意识到这些潜在的危及生命的感染并发症，并对接受痔切除术的患者的临床表现保持警惕。
