経皮内視鏡的胃瘻造設術による腹壁の壊死性筋膜炎の1例

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We report a case of abdominal wall necrotizing fasciitis caused by percutaneous endoscopic gastrostomy (PEG). An 81-year-old woman underwent an outpatient PEG for feeding at our hospital in August, 2005. She was febrile (39.3℃) 6 days after the PEG and later she was found with abdominal wall cellulitis. The patient was transferred to our hospital. She was found to have an abdominal abscess with subcutaneous air on the upper and left lateral abdomen. CT scan showed emphysema of the abdominal wall with extensive destruction of the bilateral rectus muscle and the left oblique muscle during an inflammatory process, suggesting abdominal wall necrotizing fasciitis. The patient was immediately given Meropenem and immunoglobulin and underwent an emergency surgery. Abdominal wall incision revealed that the bilateral rectus muscle and the anterior abdominal wall fascia were nonviable but the posterior abdominal wall fascia was intact. Debridement was performed following a washing and drainage of the abdominal abscess. Wound cultures showed Streptococcus constellatus. After surgery, we performed bed-side washing and debridement. Early diagnosis and prompt treatment had led to a favorable postoperative course. Finally, necrotizing fasciitis caused by PEG is a life-threatening complication ; carefully examination after PEG is of great importance.
東京女子医科大学の論文