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Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and cholecystocutaneous fistula: A Rare Case Report Presentation

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Surgical Science 2023年第5期14卷 388-397页

作者： Alexandra N. Dominianni Samantha A. Delapena Luis G. Fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews College of Medicine-Phoenix University of Arizona Phoenix AZ USA Creighton University Arizona Health Education Alliance Phoenix AZ USA Department of Surgery Division of Trauma Surgery/Surgical Critical Care The University of Texas Health Science Center Tyler TX USA The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery Tyler TX USA Trauma Wound Care UT Health East Tyler TX USA Department of Surgery University of Texas Medical Branch Galveston TX USA Adjunct Clinical Professor of Medicine and Nursing University of Texas Arlington TX USA Past Commanding General TXSG Medical Brigade Austin TX USA Surgical Resident Abrazo Health Network General Surgery Residency Glendale AZ USA Area Sales Manager Miach Orthopedics Surgical Acute Account Manager 3M Minneapolis MN USA Clinical Professor of Surgery Banner University of Arizona/University Medical Center Tucson AZ USA

Emphysematous cholecystitis is a rare subtype of acute cholecystitis characterized by the presence of gas in the gallbladder wall secondary to ischemia. Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli. The mortality rate of acute emphysematous cholecystitis is 15% - 20% compared with 1.4% in uncomplicated acute cholecystitis. The subsequent development of a cholecystocutaneous fistula, an abnormal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split-thickness skin graft.

关键词： Emphysematous Cholecystitis Gangrenous Cholecystitis cholecystocutaneous fistula Necrotizing Fasciitis Sepsis

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