A case of severe phlegmon by MRSA infection after radical hysterectomy.
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We encountered a case of severe MRSA infection after radical hysterectomy for cervical carcinoma, which required a wide resection of infected tissues with the abdomen left open. The patient was a 31-year-old parous woman and underwent radical hysterectomy for stage Ib cervical adenocarcinoma. The postoperative course was complicated by a remittent fever and the laboratory examinations showed the increase of CRP and WBC. On the 8th postoperative day, abdominal CT scan revealed an abscess in the left retroperitoneal cavity. Although a drain was indwelled in the abscess cavity, the postoperative course did not take a turn for the better. The re-laparotomy was performed to find and eradicate the focus of infection. On laparotomy, the muscle layers of the left abdominal wall and the peritoneum were thickened and hard markedly with a foul odor, thus the diagnosis of abdominal phlegmon was made. The necrotic tissues were widely resected, including the skin, subcutaneous tissues, muscles, fascia, and peritoneum. The abdominal wall was left open. The culture and sensitivity test of necrotic tissues revealed the pres ence of MRSA. Intravenous administration of vancomycin hydrochloride was commenced soon after re-laparotomy. The open abdominal wound was rinsed with saline and disinfected with povidone iodine every day for 2 months, then the abdominal wall was completely closed and covered with skin. Thereafter the course was uneventful and the patient was discharged and returned to work. The open drainage described here may be a treatment of choice in the postoperative abdominal phlegmon. [Adv Obstet Gynecol 51 (3); 191 196, 1999 (H11.5)]
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