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气单胞菌属在腹腔镜胆囊切除术后引起坏死性筋膜炎。

Aeromonas hydrophila induced necrotizing fasciitis following laparoscopic cholecystectomy.

机构信息

Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.

出版信息

J Pak Med Assoc. 2024 Mar;74(3):576-579. doi: 10.47391/JPMA.9344.

DOI:10.47391/JPMA.9344
PMID:38591302
Abstract

Necrotizi ng fasciit is [NF] i s a m ultifaceted disease of the muscle fascia and body tissues which demands the earliest intervention. Past reviews have documented ver y few cases of Aeromonas Hydroph ila [AH] induced N F fol lo wing abdominal surgery. AH can cause fatal NF as seen in a 72 year old female patient reported at Liaquat National Hospital &Medical College; a ter tiary care center in Karachi, Pakistan on 2nd April, 2022. She had a k nown comorbidity of hypertension and presented with the chief complaint of symptomatic gallstones for which she unde rwent Laparoscopic Cholecystectomy (LAPCHOL). She developed NF of the lower ab domen post- oper atively. Following uneventful Laparoscopic Cholecystectomy our pati ent presented to the ER two days later with severe lower abdo minal pain and overlyi ng celluliti s. Fasc io to my revealed extensive myonecrosis with necrotizing soft tissue in fe ction. Despite u ndergoing extensive surgical debr idement and broad spectr um antibi ot ic administration; the patient died in the ICU on the fifth postoperat ive day followi ng septic complications. Histopathologica l an alysis, confirmed i nflammat ion and necrosis. Culture sensitivity of the debrided tissue revealed AH. Approach should lie towards analyzing the behaviour of such microbes in high risk patients through collective case studies. This is the first clinical case showcasing such parameters e ncountered in the General Surger y Department.

摘要

坏死性筋膜炎 (NF) 是一种涉及肌肉筋膜和身体组织的多方面疾病,需要尽早干预。过去的研究报告记录了非常少的情况下,气单胞菌属 (AH) 在腹部手术后引起 NF。气单胞菌属可导致致命性 NF,如在 2022 年 4 月 2 日在巴基斯坦卡拉奇的利亚卡特国家医院和医学院(三级护理中心)报告的一名 72 岁女性患者中所见。她有明确的高血压合并症,主要症状为症状性胆结石,因此接受了腹腔镜胆囊切除术 (LAPCHOL)。术后她出现了下腹部 NF。在腹腔镜胆囊切除术后无并发症发生两天后,我们的患者因严重的下腹痛和弥漫性蜂窝织炎到急诊就诊。筋膜切开术显示广泛的肌坏死和坏死性软组织感染。尽管进行了广泛的清创术和广谱抗生素治疗;但患者在术后第五天因感染性并发症死于 ICU。组织病理学分析证实存在炎症和坏死。清创组织的培养药敏试验显示为气单胞菌属。应通过病例研究分析此类微生物在高危患者中的行为。这是普外科首次展示此类参数的临床病例。

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