Hamid Salik, Gadré Ashok, Fornander Liselott, Sjöwall Johanna, Muhrbeck Måns
Department of Surgery, Vrinnevi Hospital, Norrköping, Sweden.
Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Anesthesiology and Intensive Care, Vrinnevi Hospital, Norrköping, Sweden.
Int J Surg Case Rep. 2023 Apr;105:108000. doi: 10.1016/j.ijscr.2023.108000. Epub 2023 Mar 20.
Clostridial myonecrosis (CM), or gas gangrene, is a rare necrotizing muscle infection caused most often by Clostridium perfringens or C. septicum. Inoculation can occur either traumatically or spontaneously. CM has a high mortality rate if not treated promptly.
A 64-year-old male presented to the emergency department (ED) with sudden onset left flank pain and fever. Repeated CT scans demonstrated progressive edema around the left iliopsoas muscle with gas formation and bleeding. The patient received intravenous fluids, meropenem, and clindamycin. Emergency laparotomy was performed on suspicion of necrotizing fasciitis and revealed a necrotic left iliopsoas muscle which was partially excised. Blood cultures were positive at 12 h with growth of C. septicum. Prolonged stay in the intensive care unit, and six additional surgical interventions to the abdomen, left thigh, and flank were needed. The patient was discharged after four months to a nursing home.
C. septicum CM more often occurs spontaneously and is associated with colorectal malignancy. However, for our patient, CT colonography and proctoscopy did not reveal any pathology. Therefore, we believe the CM resulted from an injury the patient sustained while working in his backyard, either a cut from barbed wire on his arm or from soil contaminating his psoriatic lesions. Successful outcomes for patients with CM require a high index of suspicion, timely treatment with antibiotics, and repeated surgical debridements.
This case report describes the presentation and management of a presumably injury-related CM caused by C. septicum.
梭菌性肌坏死（CM），即气性坏疽，是一种罕见的坏死性肌肉感染，最常由产气荚膜梭菌或败血梭菌引起。接种可通过创伤性或自发性方式发生。若不及时治疗，CM死亡率很高。
一名64岁男性因突发左侧腰痛和发热就诊于急诊科。多次CT扫描显示左髂腰肌周围渐进性水肿，伴有气体形成和出血。患者接受了静脉输液、美罗培南和克林霉素治疗。因怀疑坏死性筋膜炎进行了急诊剖腹手术，发现左髂腰肌坏死，部分切除。血培养在12小时时阳性，培养出败血梭菌。患者在重症监护病房停留时间延长，还需要对腹部、左大腿和侧腹进行另外六次手术干预。四个月后患者出院，入住疗养院。
败血梭菌性CM更常自发发生，且与结直肠癌有关。然而，对于我们的患者，CT结肠成像和直肠镜检查未发现任何病变。因此，我们认为CM是患者在后院工作时受伤所致，要么是手臂被铁丝网划伤，要么是土壤污染了他的银屑病皮损。CM患者的成功治疗需要高度的怀疑指数、及时使用抗生素治疗以及反复的手术清创。
本病例报告描述了一例由败血梭菌引起的可能与损伤相关的CM的表现及治疗。
