Necrotizing Fasciitis Originating from Metastatic Colorectal Tumor Invasion-Case Report

大腸直腸癌侵犯引發後腹腔壞死性筋膜炎－罕見案例報告

林育賢(Yu-Hsien Lin) ； 林煌基(Hwang-Chi Lin) ； 周燕輝(Yenn-Hwei Chou) ； 楊菘宇(Sung-Yu Yang) ； 鄭舉緒(Chu-Hsu Jeng) ； 洪欣瑜(Hsin-Yu Hung) ； 謝承翰(Cheng-Han Hsieh) ； 洪維志(Wei-Chin Hung)

《中華民國整形外科醫學會雜誌》 18卷4期 (2009/12) Pp. 395-402

https://doi.org/10.7096/JPSA.200912.0395

摘要

背景：
後腹腔壞死性筋膜炎是一種罕見，快速病程的疾病並且往往會有致死的情形產生。其病因可能源自於骨盆腔或肛門直腸附近的感染，如婦產科疾病，大腸炎性疾病，甚至是破裂的盲腸炎等。
目的及目標：
我們提出兩個後腹腔壞死性筋膜炎併發下肢壞死性筋膜炎之病例報告。目的在探討後腹腔壞死性筋膜炎和大腸直腸癌侵犯之臨床表現，診斷，治療及文獻回顧。
材料及方法：
我們發表兩個後腹腔壞死性筋膜炎之病例報告，特別的是兩者皆導因於大腸直腸癌的侵犯所引起。第一個病例在緊急清創術後73天因嚴重的敗血症死亡。第二個病例在早期發現病兆來源，接受左側大腸腫瘤切除術，數次清創及植皮術後，於第60天順利出院。
結果：
回顧至今之文獻，只有少數的大腸直腸癌併發後腹腔壞死性筋膜炎病例報告。大部分病例皆因快速併發的敗血症而死亡。我們第二個病例是少數成功經歷重建手術及腫瘤治療手術存活下來的病例。
結論：
廣泛的壞死筋膜炎包括佛尼爾式症是高死亡率的感染疾病，因腫瘤直接侵犯而造成的病例更是罕見。我們藉由血液中腫瘤標記，影像學及組織切片，得以針對引發感染的腫瘤進行治療，減少手術次數並且改善預後。我們也藉由兩個案例報告提醒在腹壁，會陰之壞死性筋膜炎要考慮腫瘤侵犯的可能性。

並列摘要

Background:
Retroperitoneal necrotizing fasciitis is a rare, fulminate disease, and is often fatal. The etiology of retroperitoneal necrotizing fasciitis may be the result of pelvic or perirectal infection, including those of the gynaecologic and obstetric origin, colonic inflammatory disease, or even due to a ruptured appendix.
Aim and Objectives:
We present two cases with retroperitoneum and lower extremities necrotizing fasciitis and diagnosed as caused by colorectal adenocarcinoma invasion. We aim to discuss the rare etiology, clinical presentation, diagnosis and treatment.
Materials and Methods:
We present two cases report with initial presentation of retroperitoneal necrotizing fasciitis, and diagnosed as caused by colorectal adenocarcinoma invasion. Due to severe sepsis, the first patient died on day 73 after emergent fasciotomy and debridement. The second patient who received left hemicolectomy, several courses of debridement, and skin graft was discharged in good health after 60 days.
Results:
In a review of the current literature, only a few reported cases have presented with retroperitoneal necrotizing fasciitis directly caused by the colorectal cancer. Almost all of the patients in the previously published reports expired during the fulminate course of infection. Our second patient was one of the few cases who successful survived after cancer treatment and reconstruction.
Conclusion:
Extended necrotizing fasciitis including Fournier's gangrene is a potentially lethal infectious disease. Direct tumor invasion is a rare cause, but results in higher mortality from the disease. If we can provide an early diagnosis via tumor markers, image, or biopsy, we may treat the underlying disease, thereby reducing the number of operations and further improving the outcome. We also should keep in mind that extended necrotizing fasciitis of the groin areas, abdominal wall, and perineum may be related to metastatic tumor invasion.

並列關鍵字

colorectal cancer ； retroperitoneal necrotizing fasciitis ； retroperitoneum