Furste W, Dolor M C, Rothstein L B, Vest G R
Dis Colon Rectum. 1986 Dec;29(12):899-904. doi: 10.1007/BF02555374.
Traumatic, clostridial myonecrosis is a rare and serious complication of wounds. Nontraumatic, metastatic, clostridial myonecrosis may be caused by carcinoma of the large intestine. Nontraumatic myonecrosis becomes evident with localized pain, generalized toxicity, local signs of inflammation, and crepitation. Serum creatine kinase determinations may be of help in diagnosing patients suspected of having acute myonecrosis. Immediate heroic surgical intervention, usually with demonstration of Clostridium septicum, is mandatory to control the myonecrosis. Appropriate antibiotic therapy is a valuable adjunct to surgical intervention, and penicillin in massive doses appears to be the agent of choice for the clostridia. Hyperbaric oxygen therapy may help in the optimal control. General supportive measures, including frequent blood transfusions, are most important. To save the life of the patient with nontraumatic, metastatic, clostridial myonecrosis, it is necessary, as soon as the patient's general condition permits, to diagnose and eliminate the cause of the myonecrosis. In addition to the case reported, 16 cases have been reported in the literature, making a total of 17. Five patients have survived (survival rate, 29 percent).
创伤性梭菌性肌坏死是伤口罕见且严重的并发症。非创伤性转移性梭菌性肌坏死可能由大肠癌引起。非创伤性肌坏死表现为局部疼痛、全身中毒症状、局部炎症体征和捻发音。血清肌酸激酶测定可能有助于诊断疑似急性肌坏死的患者。立即进行积极的手术干预，通常要发现败血梭菌，这对控制肌坏死至关重要。适当的抗生素治疗是手术干预的重要辅助手段，大剂量青霉素似乎是治疗梭菌的首选药物。高压氧治疗可能有助于达到最佳控制效果。包括频繁输血在内的一般支持措施最为重要。为挽救非创伤性转移性梭菌性肌坏死患者的生命，一旦患者的一般状况允许，有必要诊断并消除肌坏死的病因。除了本文报道的病例外，文献中还报道了16例，共计17例。5例患者存活（存活率为29%）。
