PDF(Pubmed)
Abstract：
BACKGROUND: Infectious affections are the most frequent post-operative complications, the rate have been reducing due to the administration of perioperative antibiotics and they are rarely serious. They are usually associated to pelvic collections, fistulas, urinary tract stenosis and, exceptionally, necrotizing fasciitis (FN) and pelvic organ necrosis. There is no well-codified treatment.
METHODS: A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. Two months after surgery, the patient presented with fever. Abdominal CT scan revealed a recto-vaginal fistula. The patient underwent a surgical evacuation of the collection and a bypass colostomy. Post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs and medial left leg\'s thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required and a ligature of the left external iliac vessels. Then she received palliative treatment.she died one month after surgery because of multivisceral failure due to sepsis.
CONCLUSIONS: Necrotizing fasciitis is extremely rare and serious condition, the diagnosis is clinical and radiological, CT scan is helpful for the. There are predisposing factors such as diabetes, neoadjuvant radiotherapy or chemotherapy. The prognosis can be improved with rapid management and appropriate medical and surgical excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.
METHODS: A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. Two months after surgery, the patient presented with fever. Abdominal CT scan revealed a recto-vaginal fistula. The patient underwent a surgical evacuation of the collection and a bypass colostomy. Post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs and medial left leg\'s thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required and a ligature of the left external iliac vessels. Then she received palliative treatment.she died one month after surgery because of multivisceral failure due to sepsis.
CONCLUSIONS: Necrotizing fasciitis is extremely rare and serious condition, the diagnosis is clinical and radiological, CT scan is helpful for the. There are predisposing factors such as diabetes, neoadjuvant radiotherapy or chemotherapy. The prognosis can be improved with rapid management and appropriate medical and surgical excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.
摘要：
背景：感染是最常见的术后并发症，由于围手术期抗生素的使用，该比率一直在降低，并且很少严重。它们通常与骨盆集合有关，瘘管,尿路狭窄和,异常,坏死性筋膜炎（FN）和盆腔器官坏死。没有经过精心编纂的治疗方法。
方法：一名42岁女性患者，因宫颈IIIC2期腺癌转诊至我们部门。手术后两个月,病人出现发烧。腹部CT扫描显示直肠阴道瘘。患者接受了收集物的外科疏散和旁路结肠造口术。术后期间，盆腔器官和左腿大腿内侧肌肉发生了广泛的坏死。她还出现了左髂外静脉和动脉的血栓形成。鉴于败血症的情况,血运重建手术不可行.需要进行双侧输尿管造口术，并结扎左髂外血管。然后她接受了姑息治疗。她在手术后1个月因脓毒症导致多内脏衰竭而死亡。
结论：坏死性筋膜炎极为罕见且严重，诊断是临床和放射学的，CT扫描是有帮助的。有糖尿病等诱发因素，新辅助放疗或化疗。通过快速管理和适当的药物和手术切除坏死组织，可以改善预后。和针对可疑细菌的抗生素治疗，基本上是厌氧的。
方法：一名42岁女性患者，因宫颈IIIC2期腺癌转诊至我们部门。手术后两个月,病人出现发烧。腹部CT扫描显示直肠阴道瘘。患者接受了收集物的外科疏散和旁路结肠造口术。术后期间，盆腔器官和左腿大腿内侧肌肉发生了广泛的坏死。她还出现了左髂外静脉和动脉的血栓形成。鉴于败血症的情况,血运重建手术不可行.需要进行双侧输尿管造口术，并结扎左髂外血管。然后她接受了姑息治疗。她在手术后1个月因脓毒症导致多内脏衰竭而死亡。
结论：坏死性筋膜炎极为罕见且严重，诊断是临床和放射学的，CT扫描是有帮助的。有糖尿病等诱发因素，新辅助放疗或化疗。通过快速管理和适当的药物和手术切除坏死组织，可以改善预后。和针对可疑细菌的抗生素治疗，基本上是厌氧的。
