Halil İbrahim TAŞCI, Tevfik KÜÇÜKKARTALLAR, Mehmet Aykut YILDIRIM

Retroperitoneal nekrotizan fasciitis: yedi olgunun analizi ve literatürün gözden geçirilmesi

Nekrotizan fasciitis deri altı dokunun nadir, fakat hızlı yayılan enfeksiyoz bir hastalığıdır. Sunulan bu olgular ile amacımız retroperitoneal nekrotizan fasciitis vakalarında kliniğimizin cerrahi deneyimini ve yaklaşımını, hastalığın klinik görünümünü ve uzun dönem takip sonuçlarını literatür eşliğinde ortaya koymaktır. Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi genel cerrahi kliniğinde Ocak 2010 ve Ocak 2015 tarihleri arasında retroperitoneal nekrotizan fasciitis nedeni ile ameliyat edilen 7 hastanın verileri geriye dönük olarak değerlendirildi. Nekrotizan fasciitis, tanıda gecikildiği takdirde apandisit, ya da kas içi enjeksiyon gibi basit bir hadise sonrasında bile gelişebilecek, erken dönemde retroperitoneal alana yayılarak hastanın ölümüne sebep olabilecek ciddi bir rahatsızlıktır. Ameliyat öncesinde, özellikle gecikilmiş olduğu düşünülen vakalarda, bilgisayarlı tomografinin yardımı ile retroperitoneal bölgenin gözden geçirilmesi hem yapılacak cerrahi girişimin planlanması, hem de yetersiz debritmanı önlemek açısından önem arzetmektedir.

Retroperitoneal necrotizing fasciitis: analysis of seven cases and review of the literature

Necrotizing fasciitis is a rare but rapidly spreading infectious disease of the subcutaneous tissue. Our aim, with these presented cases, is to present the surgical approach and experience of our clinic in the cases of retroperitoneal necrotizing fasciitis and clinical presentation, long-term follow-up results of disease with the literatüre. The data collected from 7 patients, who had had surgeries because of in Necmettin Erbakan University Medical School’s general surgery clinic between January 2010 and January 2015, were retrospectively studied. Necrotizing fasciitis is a significant disease which can develop even after a simple incident like intramuscular injection or appendicitis and can lead to the death of a patient by spreading to the retroperitoneal area in the early phase in case of a delay in diagnosis. Pre-operative review of the retroperitoneal area by computerized tomography, especially in cases with potential delay, is important for both the planning of the surgical procedure and preventing insufficient debridement.

Keywords:

fasciitis, necrosis, retroperitoneum,

PDF

___

Patino JF, Castro D. Necrotizing lesions of soft tissues: a review.World J Surg. 1991;15:235-9.
Takakura Y, Ikeda S, Yoshimitsu M, Hinoi T, Sumitani D, Takeda H. Retroperitoneal abscess complicated with necrotizing fasciitis of the thigh in a patient with sigmoid colon cancer. World J Surg Oncol. 2009;7:74.
Pryror JP, Piotrowski E, Seltzer CW. Early diagnosis of retroperitoneal necrotizing fasciitis.Crit Care Med. 2001;29:1071-3.
Mahapatra SK, Nayak AK, Soren DN, Panda S, Jena J. Retroperitoneal necrotizing fascitis with adnexitis presenting as acute abdomen in a 40 year unmarried female patient: a case report. Journal of Evolution of Medical and Dental Sciences. 2014;68:13496-9.
Secil M, Topacoglu H. Retroperitoneal necrotizing fasciitis secondary to colonic diverticulitis. J Emerg Med. 2008;34:95-7.
Jayatunga AP, Caplan S, Paes TRF. Survival after retroperitoneal necrotizing fascitis. Br J Surg. 1993;80:981.
Sugimoto M, Matsuura K, Takayama H, Kayo M, Le T. Extended retroperitoneal necrotizing fascitis with genital involvement resembling fourniers gangrene. Surg Infect. 2010;11:463-7.
Tandon T, Moss MC, Shaik M, Jadhav A, Goyal S. Perforated colonic diverticulum presenting as necrotizing fasciitis of the thigh. J Orthop Sci. 2005;10:534–6.
Woodburn KR, Ramsay G, Gillespie G, Miller DF. Retroperitoneal necrotizing fasciitis. Br J Surg. 1992;79:342-4.
Ammari J, Ahssaini M, Fassi M. Retroperitoneal- necrotizing fasciitis due to chronic pyelonephritis. J Emerg Trauma Shock. 2010;3:419-20.
Wall DB, de Virgilio C, Black S. Objective criteria may assist in distinguishing necrotizing fasciitis from nonnecrotizing soft tissue infection. Am J Surg. 2000;179:17- 21.
Devin B, McCarthy A, Mehran R, Auger CC. Necrotizing fasciitis of the retroperitoneum: an unusual presentation of group A Streptococcus infection. Can J Surg. 1998;41:156-60.
Giri S, Kandel BP, Kansakar PBS, Vaidya P. Retroperitoneal necrotizing fasciitis presenting with peritonism in a 33-year-old Nepalese man: a case report. Journal of Medical Case Reports. 2012;6:53.