Abstract：
UNASSIGNED: 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.
METHODS: 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.
UNASSIGNED: 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.
CONCLUSIONS: This case report describes the presentation and management of a presumably injury-related CM caused by C. septicum.
METHODS: 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.
UNASSIGNED: 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.
CONCLUSIONS: This case report describes the presentation and management of a presumably injury-related CM caused by C. septicum.
摘要：
未经证实：梭菌坏死（CM），或者气体坏疽，是一种罕见的坏死性肌肉感染，通常由产气荚膜梭菌或败血梭菌引起。接种可以发生创伤或自发。如果不及时治疗，CM的死亡率很高。
方法：一名64岁男性因突然发作的左腹疼痛和发热就诊于急诊科（ED）。重复CT扫描显示左髂腰肌周围进行性水肿，伴有气体形成和出血。病人接受了静脉输液,美罗培南,和克林霉素。怀疑坏死性筋膜炎进行了紧急剖腹手术，发现坏死的左髂腰肌部分切除。血液培养在12小时时呈阳性，并伴有败血症的生长。长期呆在重症监护室,和另外六个腹部手术，左大腿,需要侧翼。患者在四个月后出院到疗养院。
未经评估：C.败血症CM更常自发发生，并与结直肠恶性肿瘤有关。然而,为了我们的病人,CT结肠造影和直肠镜检查未显示任何病理。因此,我们相信CM是由于病人在后院工作时受伤造成的，要么是他手臂上的铁丝网割伤，要么是污染牛皮癣病变的土壤。CM患者的成功结果需要高度怀疑，及时用抗生素治疗，和反复的手术清创。
结论：本病例报告描述了由败血症引起的可能与损伤相关的CM的介绍和处理。
方法：一名64岁男性因突然发作的左腹疼痛和发热就诊于急诊科（ED）。重复CT扫描显示左髂腰肌周围进行性水肿，伴有气体形成和出血。病人接受了静脉输液,美罗培南,和克林霉素。怀疑坏死性筋膜炎进行了紧急剖腹手术，发现坏死的左髂腰肌部分切除。血液培养在12小时时呈阳性，并伴有败血症的生长。长期呆在重症监护室,和另外六个腹部手术，左大腿,需要侧翼。患者在四个月后出院到疗养院。
未经评估：C.败血症CM更常自发发生，并与结直肠恶性肿瘤有关。然而,为了我们的病人,CT结肠造影和直肠镜检查未显示任何病理。因此,我们相信CM是由于病人在后院工作时受伤造成的，要么是他手臂上的铁丝网割伤，要么是污染牛皮癣病变的土壤。CM患者的成功结果需要高度怀疑，及时用抗生素治疗，和反复的手术清创。
结论：本病例报告描述了由败血症引起的可能与损伤相关的CM的介绍和处理。
