围产期子宫梭菌性肌坏死:两例死亡病例的报告

Laura Jacques, Bridget Kelly, Joen Soehl, Matthew Wagar, Janine Rhoades, Elise S Cowley, Peter G Pryde, Abigail Cutler, David Eschenbach
{"title":"围产期子宫梭菌性肌坏死:两例死亡病例的报告","authors":"Laura Jacques, Bridget Kelly, Joen Soehl, Matthew Wagar, Janine Rhoades, Elise S Cowley, Peter G Pryde, Abigail Cutler, David Eschenbach","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Uterine clostridial myonecrosis is a rare infection associated with a high mortality rate. This report presents 2 cases of maternal mortality resulting from peripartum clostridial myonecrosis of the uterus.</p><p><strong>Case presentation: </strong>Case 1 is a 30-year-old woman (nullipara) who presented in labor at term with an intra-amniotic infection and fetal demise. She rapidly developed septic shock, and cesarean hysterectomy was performed for a suspected necrotizing uterine infection later identified to be Clostridium septicum. Case 2 is an adolescent who presented in septic shock following first trimester medication abortion and died during emergent exploratory laparotomy; cultures grew Clostridium sordellii. Both patients expired within 18 hours of hospital admission.</p><p><strong>Discussion: </strong>Given the rapidly progressive course of clostridial infections, maintaining a high index of suspicion is imperative for ensuring timely diagnosis and effective treatment. Prompt recognition of clinical features associated with clostridial myonecrosis - abdominal pain, tachycardia, leukocytosis and hyponatremia - is essential in preventing mortality. The utilization of point-of-care ultrasound may expedite the diagnosis of uterine myonecrosis. When uterine myonecrosis is suspected, immediate initiation of penicillin-based antibiotics, alongside clindamycin, and aggressive surgical intervention including hysterectomy are essential for ensuring survival. Although the decision to perform a hysterectomy can be challenging, especially in cases involving child-bearing-aged patients, it is a vital step to avert a fatal outcome.</p><p><strong>Conclusions: </strong>By presenting these cases, we aim to raise awareness of this uncommon, but highly lethal infection to expedite diagnosis and treatment to improve patient outcomes.</p>","PeriodicalId":94268,"journal":{"name":"WMJ : official publication of the State Medical Society of Wisconsin","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Peripartum Uterine Clostridial Myonecrosis: A Report of Two Fatal Cases.\",\"authors\":\"Laura Jacques, Bridget Kelly, Joen Soehl, Matthew Wagar, Janine Rhoades, Elise S Cowley, Peter G Pryde, Abigail Cutler, David Eschenbach\",\"doi\":\"\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Uterine clostridial myonecrosis is a rare infection associated with a high mortality rate. This report presents 2 cases of maternal mortality resulting from peripartum clostridial myonecrosis of the uterus.</p><p><strong>Case presentation: </strong>Case 1 is a 30-year-old woman (nullipara) who presented in labor at term with an intra-amniotic infection and fetal demise. She rapidly developed septic shock, and cesarean hysterectomy was performed for a suspected necrotizing uterine infection later identified to be Clostridium septicum. Case 2 is an adolescent who presented in septic shock following first trimester medication abortion and died during emergent exploratory laparotomy; cultures grew Clostridium sordellii. Both patients expired within 18 hours of hospital admission.</p><p><strong>Discussion: </strong>Given the rapidly progressive course of clostridial infections, maintaining a high index of suspicion is imperative for ensuring timely diagnosis and effective treatment. Prompt recognition of clinical features associated with clostridial myonecrosis - abdominal pain, tachycardia, leukocytosis and hyponatremia - is essential in preventing mortality. The utilization of point-of-care ultrasound may expedite the diagnosis of uterine myonecrosis. When uterine myonecrosis is suspected, immediate initiation of penicillin-based antibiotics, alongside clindamycin, and aggressive surgical intervention including hysterectomy are essential for ensuring survival. Although the decision to perform a hysterectomy can be challenging, especially in cases involving child-bearing-aged patients, it is a vital step to avert a fatal outcome.</p><p><strong>Conclusions: </strong>By presenting these cases, we aim to raise awareness of this uncommon, but highly lethal infection to expedite diagnosis and treatment to improve patient outcomes.</p>\",\"PeriodicalId\":94268,\"journal\":{\"name\":\"WMJ : official publication of the State Medical Society of Wisconsin\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"WMJ : official publication of the State Medical Society of Wisconsin\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"WMJ : official publication of the State Medical Society of Wisconsin","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

简介:子宫梭菌性肌坏死是一种罕见的感染,死亡率很高。本报告介绍了两例围产期子宫梭菌性肌坏死导致产妇死亡的病例:病例 1 是一名 30 岁的产妇(无子宫),临产时出现羊膜腔内感染和胎儿夭折。她迅速出现脓毒性休克,因怀疑是坏死性子宫感染而进行了剖宫产手术,后经鉴定为败血梭菌感染。病例 2 是一名青少年,在头三个月药物流产后出现脓毒性休克,在急诊剖腹探查术中死亡;培养结果为索氏梭菌。两名患者均在入院后 18 小时内死亡:讨论:鉴于梭状芽孢杆菌感染的病程进展迅速,必须保持高度怀疑,以确保及时诊断和有效治疗。及时发现与梭菌性肌坏死相关的临床特征--腹痛、心动过速、白细胞增多和低钠血症--对预防死亡至关重要。利用护理点超声波可加快子宫肌坏死的诊断。当怀疑发生子宫肌坏死时,立即开始使用青霉素类抗生素和克林霉素,并采取积极的外科干预措施,包括子宫切除术,对确保患者存活至关重要。虽然切除子宫的决定可能具有挑战性,尤其是在涉及育龄期患者的病例中,但这是避免致命结果的重要步骤:通过介绍这些病例,我们希望提高人们对这种不常见但极具致命性的感染的认识,从而加快诊断和治疗,改善患者的预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Peripartum Uterine Clostridial Myonecrosis: A Report of Two Fatal Cases.

Introduction: Uterine clostridial myonecrosis is a rare infection associated with a high mortality rate. This report presents 2 cases of maternal mortality resulting from peripartum clostridial myonecrosis of the uterus.

Case presentation: Case 1 is a 30-year-old woman (nullipara) who presented in labor at term with an intra-amniotic infection and fetal demise. She rapidly developed septic shock, and cesarean hysterectomy was performed for a suspected necrotizing uterine infection later identified to be Clostridium septicum. Case 2 is an adolescent who presented in septic shock following first trimester medication abortion and died during emergent exploratory laparotomy; cultures grew Clostridium sordellii. Both patients expired within 18 hours of hospital admission.

Discussion: Given the rapidly progressive course of clostridial infections, maintaining a high index of suspicion is imperative for ensuring timely diagnosis and effective treatment. Prompt recognition of clinical features associated with clostridial myonecrosis - abdominal pain, tachycardia, leukocytosis and hyponatremia - is essential in preventing mortality. The utilization of point-of-care ultrasound may expedite the diagnosis of uterine myonecrosis. When uterine myonecrosis is suspected, immediate initiation of penicillin-based antibiotics, alongside clindamycin, and aggressive surgical intervention including hysterectomy are essential for ensuring survival. Although the decision to perform a hysterectomy can be challenging, especially in cases involving child-bearing-aged patients, it is a vital step to avert a fatal outcome.

Conclusions: By presenting these cases, we aim to raise awareness of this uncommon, but highly lethal infection to expedite diagnosis and treatment to improve patient outcomes.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信