U.O. Chirurgia, Unità di Ecografia Interventistica, ASL Salerno, Ospedale L. Curto, Polla, Italy.
U.O. Chirurgia, ASL Salerno, Ospedale L. Curto, Polla, Italy.
J Ultrasound. 2024 Sep;27(3):751-755. doi: 10.1007/s40477-024-00928-2. Epub 2024 Jun 28.
Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of abdominal surgery or liver transplantation. We report a case of GG of the liver occurred after percutaneous microwave (MW) ablation of an hepatocellular carcinoma (HCC) successfully treated with percutaneous Radiofrequency ablation (RFA).
A 76-year-old female patient was treated with MW ablation for a large HCC in the VIII segment; 2 days later she developed fever, weakness, abdominal swelling and was hospitalized with diagnosis of anaerobic liver abscess. Despite antibiotic therapy, the patient conditions worsened, and she was moved to the intensive care unit (ICU). Percutaneous drainage was attempted, but was unsuccessful. The surgeon and the anesthesiologist excluded any indication of surgical resection. We performed RFA of the GG by 3 cool-tip needles into the infected area. The procedure was well tolerated by the patient, who left the hospital for follow-up.
Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients refractory to antibiotics and when surgery and OLT are not feasible. A fast and early indication is needed in case of rapid worsening of the patient's conditions.
气性坏疽（Gas gangrene，GG）是一种罕见的严重感染，主要由梭状芽孢杆菌引起，死亡率非常高。它通常是腹部手术或肝移植的并发症，突然发生。我们报告了一例经皮微波（MW）消融肝细胞癌（HCC）后发生的 GG，经皮射频消融（RFA）成功治疗。
一名 76 岁女性患者因 VIII 段大 HCC 接受 MW 消融治疗；2 天后出现发热、乏力、腹胀，并因厌氧性肝脓肿住院。尽管给予抗生素治疗，患者病情仍恶化，并转入重症监护病房（ICU）。尝试了经皮引流，但未成功。外科医生和麻醉师排除了手术切除的任何指征。我们通过 3 根冷尖端针将 GG 患者的感染区域进行 RFA。患者对该过程耐受良好，出院随访。
对于抗生素治疗无效且手术和 OLT 不可行的肝局灶性 GG 患者，经皮 RFA 可能是一种有价值的治疗方法。在患者病情迅速恶化的情况下，需要快速和早期的治疗。
