1
|
Li L, Abe K, Okamoto T, Matsumoto M, Futagawa Y, Kanehira M, Ikegami T. A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy. Surg Case Rep 2022; 8:74. [PMID: 35461435 PMCID: PMC9035194 DOI: 10.1186/s40792-022-01418-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis after pancreaticoduodenectomy (PD) has never been reported. We experienced a case of necrotizing fasciitis caused by pseudoaneurysmal hemorrhage after PD. CASE PRESENTATION A 72-year-old male was diagnosed with cholangiocarcinoma and underwent PD. Bile leakage was detected postoperatively, conservatively resolved, and the patient was discharged on the 36th day after surgery. On the 42nd day after surgery, a pseudoaneurysm of the gastroduodenal artery ruptured. Transcatheter arterial embolization was performed for hemostasis: however, a large intra-abdominal abscess caused by an infected hematoma was recognized. On the 57th day after surgery, the patient developed necrotizing fasciitis. He underwent debridement with skin reconstruction using a latissimus dorsi flap and skin transplantation. Costochondritis and liver metastasis were detected on the 267th day after surgery. Infection was controlled by rib cartilage resection, debridement, and negative pressure wound therapy. Chemotherapy involving gemcitabine and cisplatin was initiated on the 460th day after the initial surgery with a partial response (PR) and was continued for more than one year. CONCLUSIONS We herein reported a rare case of necrotizing fasciitis following hematoma infection after PD that was treated using multidisciplinary therapy with PR following chemotherapy.
Collapse
Affiliation(s)
- Lulu Li
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, Japan
| | - Kyohei Abe
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo, Japan.
| | - Tomoyoshi Okamoto
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo, Japan
| | - Michinori Matsumoto
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo, Japan
| | - Yasuro Futagawa
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo, Japan
| | - Masaru Kanehira
- Department of Surgery, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo, Japan
| | - Toru Ikegami
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo, Japan
| |
Collapse
|
2
|
Sablone S, Lagouvardou E, Cazzato G, Carravetta F, Maselli R, Merlanti F, Bavaro DF, De Donno A, Introna F, Caputi Iambrenghi O. Necrotizing Fasciitis of the Thigh as Unusual Colonoscopic Polypectomy Complication: Review of the Literature with Case Presentation. Medicina (Kaunas) 2022; 58:medicina58010131. [PMID: 35056439 PMCID: PMC8780250 DOI: 10.3390/medicina58010131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms.
Collapse
Affiliation(s)
- Sara Sablone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
- Correspondence: or
| | - Elpiniki Lagouvardou
- Section of General Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (E.L.); (O.C.I.)
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari, 70124 Bari, Italy;
| | - Francesco Carravetta
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Roberto Maselli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Francesco Merlanti
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Davide Fiore Bavaro
- Section of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari, 70124 Bari, Italy;
| | - Antonio De Donno
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Francesco Introna
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (F.C.); (R.M.); (F.M.); (A.D.D.); (F.I.)
| | - Onofrio Caputi Iambrenghi
- Section of General Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy; (E.L.); (O.C.I.)
| |
Collapse
|