Necrotizing fasciitis with Clostridium perfringens after laparoscopic cholecystectomy.
Necrotizing fasciitis is a rapidly progressive infection of the fascia and subcutaneous tissues accompanied by a high mortality rate approaching 80% to 100%. Factors that predispose patients to this life-threatening complication include obesity, malnutrition, malignancy, chronic alcoholism, drug abuse, peripheral vascular disease, diabetes mellitus, and immunosuppressive therapy. The pathomechanisms for the development of this rare disease still remain unclear. We report a case of necrotizing fasciitis with Clostridium perfringens after laparoscopic cholecystectomy. The patient left the hospital 5 months after admission. Early recognition based on clinical signs (pain, asymmetric abdominal thickening, crepitus) and computed tomography scanning (gas dissection along fascial planes), in conjunction with prompt, aggressive surgical therapy and debridement of all devitalized tissue, high-dose antibiotic therapy, and therapy at the intensive care unit, appears to afford patients the best chance of survival.
Mittermair
R P
RP
Department of General Surgery, University Hospital Innsbruck, University of Innsbruck, Anichtrasse 35, A-6020 Innsbruck, Austria. reinhard.mittermair@tirol.com
Schobersberger
W
W
Hasibeder
W
W
Allerberger
F
F
Peer
R
R
Bonatti
H
H
D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D003016:Clostridium perfringens / Q000187:drug effects / Q000302:isolation & purification*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*