PDF(Pubmed)
Abstract：
Necrotizing soft tissue infection (NSTI) is a rapidly progressive infection of the soft tissues that necessitates early identification and emergent aggressive surgical debridement due to its high mortality. NSTI most often results from the introduction of microbes through breaks in the skin. Unique sources, like appendiceal fistulae, can be etiologies of abdominal wall NSTIs. We present the case of a 46-year-old female with a past medical history of poorly controlled type II diabetes mellitus and ventral hernia who presented in septic shock with a necrotic wound in her abdominal wall. The wound was overlying a large ventral hernia and was consistent with NSTI. She was treated urgently with fluid resuscitation, antibiotic therapy, and surgical debridement of the wound. On repeat exploration, an appendiceal fistula was found protruding from the hernial sac. Open appendectomy and primary repair of the ventral hernia were performed. Principles of immediate intervention and repeat surgical debridement allowed control of the septic insult and definitive source control upon identification of an appendiceal fistula.
摘要：
坏死性软组织感染（NSTI）是软组织的快速进行性感染，由于其高死亡率，因此需要早期识别和紧急积极的手术清创。NSTI最常见的结果是通过皮肤中的破裂引入微生物。独特的来源，比如阑尾瘘,可能是腹壁NSTIs的病因。我们介绍了一名46岁的女性，其既往有II型糖尿病和腹侧疝控制不佳的病史，该患者在感染性休克中表现为腹壁坏死伤口。伤口覆盖大的腹侧疝，与NSTI一致。她接受了液体复苏的紧急治疗，抗生素治疗,以及伤口的手术清创.在重复探索时，阑尾瘘从疝囊突出。进行了开腹阑尾切除术和腹疝的初次修复。立即干预和重复手术清创术的原则允许在确定阑尾瘘后控制败血症和明确的来源控制。
