Necrotizing fasciitis of the thigh due to penetrated descending colon cancer: a case report.
Necrotizing fasciitis of the thigh due to penetrated descending colon cancer: a case report.
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DOI：
10.1186/s40792-018-0544-y
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发表时间：
2018-11-26
影响因子：
0.8
通讯作者：
Hakamada K
中科院分区：
文献类型：
--
作者：
Sato K;Yamamura H;Sakamoto Y;Morohashi H;Miura T;Yoshikawa T;Suto A;Tsuruta S;Hakamada K
由结直肠癌引起的坏死性筋膜炎（NF）是罕见的，并且很少有与结肠癌相关的病例报告。我们描述的情况下，与NF患者在左大腿由于降结肠癌的渗透谁是一个阶段的手术切除治疗，而不创建一个造口。一名80岁的妇女被带到我们医院抱怨发烧和身体活动困难。体格检查显示从左下腹到左股骨区域的皮下气肿。CT显示降结肠周围脓肿形成伴肺气肿，降结肠壁增厚，怀疑结肠癌。由于降结肠癌渗透，该患者随后被诊断为NF。行左半结肠切除术和左股部开放引流术。组织病理学结果为高分化腺癌，肿瘤生长穿过浆膜（T4a），无淋巴结转移（N0）。手术后，患者接受了脓毒性休克和开放引流部位灌洗的重症监护，脓毒症逐渐得到控制。在引流部位闭合后，患者在术后26天被转移到另一家医院，她有6个月的无复发生存期。在结肠癌引起的NF中，早期一期切除可改善肿瘤学结局。应仔细评估身体状况，如果患者有能力接受该手术，应考虑一期切除。
Necrotizing fasciitis (NF) caused by colorectal cancer is rare, and very few cases associated with colon cancer have been reported. We describe the case of a patient with NF in the left thigh due to penetration of descending colon cancer who was treated with one-stage surgical resection without creating a stoma. An 80-year-old woman was brought to our hospital complaining of fever and difficulty with body movement. A physical examination showed subcutaneous emphysema from the left lower abdomen to the left femoral region. CT showed abscess formation with emphysema around the descending colon, and the wall of the descending colon was thickened, which led to suspicion of colon cancer. The patient was subsequently diagnosed with NF due to penetration of descending colon cancer. Left hemicolectomy and open drainage of the left femoral region was performed. The histopathological findings were well-differentiated adenocarcinoma, with the tumor grown through the serosa (T4a) and with no metastasis to lymph nodes (N0). After surgery, the patient received intensive care for septic shock and lavage of the open drainage site, and sepsis was controlled progressively. After closure of the drainage site, the patient was transferred to a different hospital at 26 days after surgery, and she has had 6-month relapse-free survival. In NF caused by colon cancer, early one-stage resection may improve the oncological outcome. Physical status should be assessed carefully, and one-stage resection should be considered if the patient has the capacity to undergo this procedure.