Bowel Perforation and Necrotizing Fasciitis after Ultrasound-Assisted Liposuction - A Case Report

超音波抽脂手術後併發腸穿孔及壞死性筋膜炎－病例報告

張欽富(Chin-Fu Chang) ； 賴志昇(Chih-Sheng Lai) ； 陳彥瑋(Yen-Wei Chen) ； 呂俊德(Chun-Te Lu) ； 顏榮信(Jung-Hsing Yen) ； 陳伊呈(I-Chen Chen)

《臺灣整形外科醫學會雜誌》 26卷2期 (2017/06) Pp. 222-231

摘要

Background: Liposuction is a popular aesthetic procedures performed worldwide, but it is not without risk. Major and minor complications following it have frequently been described in studies conducted in numerous countries. Bowel perforation and necrotizing fasciitis (NF) after a liposuction procedure are major complications, and while rare, they are often underestimated. Aim and Objectives: In this report, bowel perforation and NF occurred following ultrasound-assisted liposuction (UAL), and we propose major risk factors and possible mechanisms of its development, and discuss how to avoid it. Material and Methods: A 57-year-old woman with previous abdominal operation presented to the emergency department 2 days after undergoing abdominal UAL at a plastic surgery clinic. She received intravenous empiric antibiotics and fluid supplement under the impression of infectious myonecrosis. However, she presented peritoneal signs and developed septic shock on postoperative day 9. Additionally, a large and irregular-bordered violaceous discoloration patch was noted on the right abdominal wall. Bowel perforation and NF were suspected, and she underwent emergent exploratory laparotomy and fasciectomy in right abdomen. Results: A perforation of abdominal fascia was noted during the operation, and a perforation of ascending colon was confirmed by later pathology findings. Furthermore, the NF secondary to bowel perforation was indicated by enteric bacteria identified in bacterial cultures from her fasciectomy site. Owing to severe sequelae of peritonitis, bowel resection, complications of long-term parenteral nutrition and wound infection, she had a prolonged intensive care. When her condition had progressed and oral food intake was tolerated, she was discharged after 280 days of hospitalization. Conclusion: Bowel perforation and NF following abdominal liposuction are attributable to multiple risk factors, which are related previous abdominal surgery, obesity, treatment option of liposuction and surgical techniques. In our case, the effects of ultrasonic energy itself could not be fully incriminated. It's important for clinicians to perform physical examination preoperatively with adequate documentation of the patient's surgical history. Additionally, they should also take certain precautions during the procedure and perform careful physical examinations in follow-up visits to avoid life-threatening complications.

關鍵字

bowel perforation ； necrotizing fasciitis ； ultrasound-assisted liposuction

並列摘要

背景：抽脂手術是全世界受歡迎的美容手術，但並非無風險。世界各國發表的文章不乏對此手術後的輕微與嚴重併發症的描述。抽脂手術過程中所導致的腸穿孔及壞死性筋膜炎是嚴重併發症，雖罕見但常被低估其嚴重性。目的及目標：提出一例在接受超音波抽脂手術後併發腸穿孔及壞死性筋膜炎的病例。在此提出主要的風險因素、可能的致病機制，並且討論如何避免此嚴重併發症。材料及方法：一名57歲有腹部手術病史的婦女，在整形美容外科診所接受腹部超音波抽脂手術後第二天，被送至急診室。在疑似診斷為感染性肌肉壞死後，接受經驗性抗生素靜脈注射及輸液治療。然而在抽脂手術後第九天病人出現腹膜炎及敗血性休克症狀，此外在病患右腹壁可見大範圍且邊緣不規則的紫斑。因懷疑為腸穿孔及壞死性筋膜炎，病患接受緊急剖腹探查和右腹部筋膜切開手術。結果：術中發現一個腹壁筋膜層的穿孔，且筋膜切開的腹壁傷口細菌培養顯示皆為腸內菌，得知壞死性筋膜炎是續發於腸穿孔，而升結腸穿孔也藉由病理證實。病人由於腹膜炎的嚴重後遺症、腸切除、長時間靜脈營養及傷口感染而接受長時間的重症照護，在整體病況好轉且可由口進食後出院，住院期間共280天。結論：腹部抽脂手術併發腸穿孔及壞死性筋膜炎有多種風險因素，包含先前腹部手術、肥胖、抽脂儀器的選擇及手術技巧，而此病例中的併發症無法完全歸咎於超音波抽脂。最重要的是臨床醫師在手術前應充分了解病患先前的手術史並徹底執行理學檢查，此外手術過程中需執行預防措施，並進行術後追蹤。若懷疑有此併發症之可能，應安排詳細的檢查以免併發症威脅生命。