HEMOROİDEKTOMİ SONRASI NEKROTİZAN FASİİT

Yıl 2024, Cilt: 38 Sayı: 2, 103 - 109, 28.08.2024

Arda Şakir Yılmaz , Yasin Ekici , Bartu Badak

https://doi.org/10.18614/deutip.1308616

Öz

Nekrotizan fasiit (NF); genellikle alt ekstremite ve perianal bölgeyi tutan, ciltten fasyaya kadar uzanan, progresif bir yumuşak doku enfeksiyonudur. Sıklıkla yaşlılarda görülmesine rağmen yandaş hastalıklar, geçirilmiş cerrahi öyküsü ve immün sistem bozuklukları olan her yaş grubunda görülebilmektedir. Hızlı doku istilası sonucu gelişen NF, erken tanı ve erken cerrahi debridman yapılamaz ise ciddi morbidite ve mortaliteye sebep olabilmektedir. Bu nedenle klinikte lezyon ile orantısız ağrı, ateş ve septik belirteçler varsa NF den şüphelenilmelidir. NF’nin tedavisinde en önemli basamak erken cerrahi debridman ve uygun antibiyoterapi başlanmasıdır. Ayrıca bu tedavilerin yanında çeşitli yara bakım tedavileri de uygulanabilmektedir. Biz de hemoroidektomi sonrası NF gelişen bir olguda tanıdan taburculuğa geçen süreci, tedavi yönetimi açısından anlatmaya çalıştık.

Anahtar Kelimeler

Nekrotizan fasiit, fasyotomi, hemoroid

NECROTIZING FACICIT AFTER HEMOROIDECTOMY

Öz

Necrotizing fasciitis (NF); is a progressive soft tissue infection involving the lower extremities and perianal region, extending from the skin to the fascia. Although it is frequently seen in the elderly, it can be seen in all age groups with concomitant diseases, previous surgery history, and immune system disorders. NF, which develops as a result of rapid tissue invasion, can cause serious morbidity and mortality if early diagnosis and early surgical debridement are not performed. Therefore, NF should be suspected if pain, fever, and septic markers are disproportionate to the lesion in the clinic. The most important step in the treatment of NF is early surgical debridement and initiation of appropriate antibiotics. In addition to these treatments, various wound care treatments can also be applied. We tried to explain the process from diagnosis to discharge in a patient who developed NF after hemorrhoidectomy in terms of treatment management.

Anahtar Kelimeler

Necrotizing fasciitis, fasciotomy, hemorrhoids

Kaynakça

• 1. Legbo JN, Shehu BB. Necrotizing fasciitis: a comparative analysis of 56 cases. Journal of the National Medical Association. 2005;97(12):1692-1697.
• 2. Arif N, Yousfi S, Vinnard C. Deaths from necrotizing fasciitis in the United States, 2003-2013. Epidemiology and infection, 2016;144(6):1338-1344.
• 3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014;59(2):147-159.
• 4. McDonald LS, Shupe PG, Raiszadeh K, Singh A. Misdiagnosed pneumothorax interpreted as necrotizing fasciitis of the chest wall: case report of a potentially preventable death. Patient safety in surgery, 2014;8:20.
• 5. Napolitano LM. Severe soft tissue infections. Infectious disease clinics of North America,2009;23(3):571-591.
• 6. Weimer SB, Matthews MR, Caruso DM, Foster KN. Retroperitoneal Necrotizing Fasciitis from Fournier's Gangrene in an Immunocompromised Patient. Case reports in surgery, 2017;2017:5290793.
• 7. Chen Y, Wang X, Lin G, Xiao R. Successful treatment following early recognition of a case of Fournier's scrotal gangrene after a perianal abscess debridement: a case report. Journal of medical case reports, 2018;12(1):193.
• 8. Baig MZ, Aziz A, Abdullah UEH, Khalil MS, Abbasi S. Perianal Necrotizing Fasciitis with Retroperitoneal Extension: A Case Report from Pakistan. Cureus, 2019;11(7):e5052.
• 9. Roje Z, Roje Z, Matić D, Librenjak D, Dokuzović S, Varvodić J. Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs. World journal of emergency surgery : WJES, 2011;6(1):46.
• 10. Golger A, Ching S, Goldsmith CH, Pennie RA, Bain JR. Mortality in patients with necrotizing fasciitis. Plastic and reconstructive surgery, 2007;119(6):1803-1807.
• 11. Myers CM, Miller JJ, Davis WD. Skin and Soft Tissue Infections: A Case of Necrotizing Fasciitis. Advanced emergency nursing journal, 2019;41(4):322-329.
• 12. Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. International journal of dermatology, 2007;46(10):1036-1041.
• 13. Wong CH, Wang YS. The diagnosis of necrotizing fasciitis. Current opinion in infectious diseases, 2005;18(2):101-106.
• 14. Leiblein M, Marzi I, Sander AL, Barker JH, Ebert F, Frank J. Necrotizing fasciitis: treatment concepts and clinical results. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2018;44(2):279-290.
• 15. Cheng NC, Tai HC, Chang SC, Chang CH, Lai HS. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC infectious diseases, 2015;15:417.