- 期刊
Retroperitoneal Necrotizing Fasciitis Secondary to Ruptured Appendicitis-Two Cases Report
破裂性闌尾炎併發後腹腔壞死性筋膜炎－個案報告
摘要
背景：壞死性筋膜炎為病程發展快速且易致命疾病，發生於後腹腔並不多見。為闌尾炎破裂所病發者僅見於少數文獻，試討論二名本院病患其危險因子、診斷、治療與預後。案例分析：一名58歲男性因破裂性闌尾炎於外院經手術治療併發後腹腔壞死筋膜炎，轉至本院治療；另一名48歲糖尿病男性患者因長期右腰際膿瘍至本院求診，主訴無任何腹部病史及症狀，最後診斷為慢性破裂性闌尾炎所致。兩名患者均接受手術及抗生素治療，術後預後良好，追蹤無復發情形。 討論：回顧過去文獻，闌尾性破裂併發壞死筋膜炎僅見於少數文獻。危險因子包含免疫不全、腹內疾病、老年…等等。以解剖位置而言，破裂性闌尾炎可延前後腹腔筋膜進而感染後腹腔，而導致大範圍軟組織壞死。致病菌多為腸內菌。藉由影像學診斷及早期投予抗生素及手術，順利治癒本院兩名患者。 結論：糖尿病及腹內疾病為顯著危險因子。即使無腹部症狀疾病史，慢性闌尾炎破裂亦須列入頑固性右腰膿瘍的鑑別診斷。不論慢性或急性闌尾炎皆可能造成後腹腔壞死性筋膜炎進而威脅生命。及早診斷、治療可改善存活率。
關鍵字
無資料並列摘要
Appendicitis is a common disease of acute abdomen, and retroperitoneal necrotizing fasciitis (RNF) which means infection involved the retro peritoneal space is the relatively rare and fatal complications reported so far as we know. We present two cases affected by RNF due to perforated appendicitis and review the related literatures to identify the possible mechanism, risk factors and therapeutic strategies. The first patient was transferred to our hospital due to RNF after open appendectomy for acute ruptured appendicitis. The other case is a type 2 DM patient and has been bothered by obstinate abscess formation over right flank for a long period of time. Chronic appendicitis complicated with RNF was diagnosed finally although no abdominal symptoms were associated with it. Both of them received surgical and medical therapy, and has no recurrence after our treatment. In conclusion, immunocompromised status and intra-abdominal comorbidities are high risk factors. Both of the acute and chronic appendicitis may result in the lethal necrotizing fasciitis spreading along the retroperitoneal space similarly. Early and prompt wide debridement, broad-spectrum antibiotic therapy, constructive resuscitation, and prevention of nosocomial infection may improve the survival rate.
延伸閱讀
- Liu, S. H., & Yang, C. C. (2004). 腹腔鏡闌尾切除手術後之下消化道出血：個案報告. Formosan Journal of Surgery, 37(3), 138-142. https://www.airitilibrary.com/Article/Detail?DocID=10116788-200406-37-3-138-142-a
- Sun, T. B., Lin, C. I., Horng, S. Y., & Chen, M. T. (1997). 右脅部壞死性筋膜炎－穿孔性闌尾炎之罕見表徵. 中華民國重建整形外科醫學會雜誌, 6(1), 42-47. https://doi.org/10.7096/JPRSA.199703.0042
- Yin, J. T., Chen, J. L., & Shieh, S. J. (2019). 穿孔性大腸憩室炎引起之後腹腔壞死性筋膜炎－病例報告. 臺灣整形外科醫學會雜誌, 28(4), 296-304. https://www.airitilibrary.com/Article/Detail?DocID=a0000593-201912-202001140018-202001140018-296-304
- Tsai, B. R., Liu, P. H., Lin, T. H., Hii, C. H., & Juan, C. W. (2018). 闌尾炎破裂併發福尼爾氏壞疽：個案報告. 弘光學報, (82), 21-25. https://doi.org/10.6615/HAR.201809_(82).0003
- Lam, H. B., Liu, T. P., & Jeng, K. S. (1998). 急性闌尾炎於內臟逆位：病例報告. 中華民國急救加護醫學會雜誌, 9(4), 171-174. https://doi.org/10.30018/JECCM.199812.0008