剖腹产后导致经腹子宫切除术的坏死性筋膜炎。

Pub Date : 2024-09-30 eCollection Date: 2024-07-01 DOI:10.1055/a-2414-7696
Alvina Liang, Mary Boluwatife Idowu, Steven Joseph Eskind, Soha S Patel
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引用次数: 0

摘要

坏死性筋膜炎(NF)是一种罕见但危及生命的疾病,其特点是炎症迅速扩散,随后筋膜平面和周围组织坏死。有限的文献描述 NF 涉及筋膜平面以外的邻近实体器官,需要将其切除。我们介绍了一例 25 岁的白人女性病例,她接受了剖腹产手术,随后患上了 NF,并累及子宫和腹壁,需要进行全腹子宫切除术、坏死组织的连续手术清创以及伤口真空辅助闭合(VAC)置入术。病理报告显示,她的子宫被多杆菌浸润,确诊为 NF。尽管 NF 具有渐进性和潜在的致命性,但由于缺乏致病体征和症状,临床诊断 NF 具有一定难度。然而,利用白细胞计数、血红蛋白、血钠、血糖、血清肌酐和 C 反应蛋白等实验室值计算坏死性筋膜炎实验室风险指标评分,及早发现 NF 对患者的最佳治疗效果至关重要。在治疗这些患者时,多学科团队的方法对清除坏死组织和控制感染可能造成的后遗症至关重要,尤其是对产后患者而言。
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Necrotizing Fasciitis Post-Cesarean Section Leading to Transabdominal Hysterectomy.

Necrotizing fasciitis (NF) is a rare but life-threatening disease characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissues. Limited literature has described NF as involving an adjacent solid organ beyond fascial planes that has required its removal. We present a case of a 25-year-old white female who underwent a cesarean section and subsequently developed NF involving her uterus and abdominal wall that necessitated a total abdominal hysterectomy, serial surgical debridement of necrotic tissue, and wound vacuum assisted closure (VAC) placement. Her pathology report described her uterus infiltrated by polybacteria, confirming a diagnosis of NF. Despite NF's progressive nature and potential lethality, NF can be challenging to diagnose clinically due to a lack of pathognomonic signs and symptoms. However, early detection of NF with the aid of Laboratory Risk Indicator for Necrotizing Fasciitis score calculation using laboratory values such as white blood cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein is critical for optimal patient outcomes. A multidisciplinary team approach is vital in treating these patients to debride necrotizing tissue and control the potential sequelae from the infection, particularly for postpartum patients.

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