Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation  

作　　者：Alexandra N. Dominianni Samantha A. Delapena Luis G. Fernandez Mostaffa T. Jabassini Sean F. O’Keefe Rachel L. Villanueva Marc R. Matthews 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)

机构地区：[1]College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA [2]Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA [3]Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, The University of Texas Health Science Center, Tyler, TX, USA [4]The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery, Tyler, TX, USA [5]Trauma Wound Care, UT Health East, Tyler, TX, USA [6]Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA [7]Adjunct Clinical Professor of Medicine and Nursing, University of Texas, Arlington, TX, USA [8]Past Commanding General TXSG Medical Brigade, Austin, TX, USA [9]Surgical Resident, Abrazo Health Network General Surgery Residency, Glendale, AZ, USA [10]Area Sales Manager, Miach Orthopedics [11]Surgical Acute Account Manager, 3M, Minneapolis, MN, USA [12]Clinical Professor of Surgery, Banner University of Arizona/University Medical Center, Tucson, AZ, USA

出　　处：《Surgical Science》2023年第5期388-397,共10页外科学（英文）

摘　　要：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.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 

分 类 号：R57[医药卫生—消化系统]