Iemura Shunki, Mori Shigeshi, Kamiya Masato, Yamazaki Kenji, Kobayashi Takaya, Akagi Masao, Togawa Daisuke
Departments of Orthopedics and Rheumatology, Kindai University Nara Hospital, 1248-1 Otodacho, Ikoma, Nara, 630-0293, Japan.
Department of Orthopedic Surgery, Kindai University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
Ann Med Surg (Lond). 2022 May 31;79:103882. doi: 10.1016/j.amsu.2022.103882. eCollection 2022 Jul.
Iliopsoas and iliacus abscesses are caused by hematogenous and lymphatic infections and the spread of inflammation in neighboring organs. A small number of cases have been reported in which inflammation spread not only within the iliopsoas muscle but also to the thigh. Here we report a case of retroperitoneal infiltration and perforation of cecal cancer that caused extensive abscess formation from the iliacus muscle to the thigh.
An 80-year-old man who had undergone chemotherapy for cecal cancer had abdominal pain and right thigh pain without any particular attraction. CT images showed extensive abscess formation from the iliacus muscle to the subcutaneous part of the thigh due to retroperitoneal infiltration and perforation of cecal cancer. Ileocecal resection, colostomy, and retroperitoneal abscess drainage were performed for perforation of cecal cancer and pelvic abscess. Although the thigh was initially drained by a small incision, the infection did not heal. Extensive debridement and drainage were required for all of the contaminated areas, and after all the infection was completely cured.
The optimal treatment for an abscess that has spread from the inguinal region to the thigh is unclear. In this case, active debridement and drainage of the infected area were effective and should have been done early.
We believed that debridement and drainage should have been performed from the time of the first surgery not only by the small incision drainage but also for all of the contaminated areas when the infection had been widespread.
髂腰肌和髂肌脓肿由血行性和淋巴性感染以及邻近器官炎症蔓延所致。少数病例报告显示炎症不仅在髂腰肌内扩散，还蔓延至大腿。在此，我们报告一例盲肠癌腹膜后浸润并穿孔导致从髂肌至大腿广泛脓肿形成的病例。
一名曾接受盲肠癌化疗的80岁男性出现腹痛和右大腿疼痛，无特殊诱因。CT图像显示由于盲肠癌腹膜后浸润和穿孔，从髂肌至大腿皮下部分形成广泛脓肿。针对盲肠癌穿孔和盆腔脓肿进行了回盲部切除术、结肠造口术及腹膜后脓肿引流。尽管最初通过小切口对大腿进行了引流，但感染未愈合。对所有污染区域均需进行广泛清创和引流，直至所有感染完全治愈。
从腹股沟区域蔓延至大腿的脓肿的最佳治疗方法尚不清楚。在本病例中，对感染区域进行积极清创和引流是有效的，且应尽早进行。
我们认为，从首次手术时起，不仅应通过小切口引流，而且当感染广泛时应对所有污染区域进行清创和引流。
