Abdominal and/or Flank Necrotizing Fasciitis Secondary to Intra-abdominal Processes-NTUH Series

原發性軀幹部壞死性筋膜炎：後發於腸胃道病因－台大經驗

吳名倫(Ming-Luen Wu) ； 陳右昇(Yo-Shen Chen) ； 陳明庭(Ming-Ting Chen) ； 洪學義(Shyne-Yih Horng) ； 戴浩志(Hao-Chih Tai) ； 謝孟祥(Mon-Hsian Hsieh) ； 簡雄飛(Hsiung-Fei Chien) ； 湯月碧(Yueh-Bih Tang)

《中華民國整形外科醫學會雜誌》 14卷2期 (2005/06) Pp. 111-120

https://doi.org/10.7096/JPSA.200506.0111

摘要

壞死性筋膜炎是死亡率相當高的大範圍軟組織感染，其中影響的範圍，又以軀幹部及四肢為大宗。在軀幹部壞死性筋膜炎中又可分為原發性及次發性，次發性軀幹部壞死性筋膜炎，絕大多數起因於腹部手術後之併發症。而原發性軀幹部壞死性筋膜炎在文獻記載中並不多見，也因較不易早期診斷進行治療，其死亡率相對於其他部位之壞死性筋膜炎也來的高。本研究整理了過去十年來台大醫院所有原發性軀幹部壞死性筋膜炎的病例，希望能夠找出腸胃道病因與原發性軀幹部壞死性筋膜炎之間的相關性，同時也對此疾病的預後作出探討。

並列摘要

We present a unique case of necrotizing fasciitis of the abdomen with bilateral flank involvement, which was secondary to a fistula formation between the colon and the rectus muscle fascia, Group B Salmonella infection is believed to be the cause of initial colon perforation that led to the subsequent fistula formation. To the best of our knowledge, such a case has never been reported in the literatures.
This unique case led us further to question if isolated abdominal and/or flank necrotizing fasciitis without previous history of trauma or operation are intra-abdominal origin. We retrieved all record of patients diagnosed with necrotizing fasciitis in our hospital from January 1992 to January 2002. A total of 150 patients was identified and confirmed. We found that isolated abdominal and/or flank necrotizing fasciitis without previous trauma or operation is in deed a rare occurrence, and only six such patient was identified (3 male, 3 female) counting for a mere 4 percent of 150 patient of necrotizing fasciitis.
All six cases of isolated abdominal and/or flank necrotizing fasciitis presented as a spontaneous, isolated event, and all were intra-abdominal origin. Unfortunately, five cases resulted in mortality. From this review, we suggest that (1) necrotizing fasciitis involving the abdominal wall carries a very poor prognosis than the necrotizing fasciitis involving other regions; and (2) when presented with a seemingly spontaneous and isolated abdominal and/or flank necrotizing fasciitis, an entry from the digestive tract should be greatly suspected.

並列關鍵字

human ； necrotizing fasciitis ； abdominal necrotizing fasciitis ； entero-cutaneous fistula ； sigmoid colon cob-cutaneous fistula ； Salmonella 04 group B infection