直腸吻合部狭窄形成後に発症した重症壊死性筋膜炎の救命例

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  • A Case of Necrotizing Fasciitis Caused by Surgical Treatment for Anastomotic Stenosis of the Rectum

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The case of a 64-year-old male patient who underwent a low anterior resection for rectal cancer in February 1999 was followed up. A digital examination indicated postoperative anastomotic stenosis of the rectum. Dilation by ballooning had been performed every few months since the surgery ; however, his local findings gradually deteriorated. A wedge resection of the operative scar at the site of the anastomosis was performed in May 2005. The next day, the patient became confused and hypotensive. CT scans demonstrated perianorectal gas. The patient was diagnosed as having necrotizing fasciitis with septic shock. Drainage of the inflammatory exudates in the retroperitoneum and the pelvic cavity was performed as an emergency procedure under general anesthesia after immediate endotoxin elimination therapy (PMX-DHP). Widespread inflammation had extended to the lower abdomen and the left scrotum. Aggressive postoperative debridement of the musculus rectus abdominis and musculus obliquus externus/internus abdominis was performed, and the open wound was irrigated daily. Intensive treatment under the administration of systemic antibiotics, continuous hemodiafiltration (CHDF), and a ventilator were used during the patient's recovery from multiple organ failure. Ultimately, a skin graft was required. In conclusion, it is important to be aware of the possibility of the recurrence of necrotizing fasciitis during the postoperative surgical dilation of an anastomotic stenosis of the rectum. If a diagnosis of necrotizing fasciitis is made, an emergency surgical debridement should be undertaken with an intensive treatment that would include apheresis therapy (PMX-DHP and CHDF).

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