Diagnosis and Treatment of Combination of Acute Necrotizing Fasciitis and Severe Septic Shock after Operation for Rectal Cancer

XIAO Jian-guo; KANG Hong-jun; LIU Hui; MAO Zhi; PAN Liang; ZHAO Yan; ZHOU Fei-hu

doi:10.3969/j.issn.1002-3429.2017.02.019

Abstract：Objective To investigate risk factors, clinical characteristics, key points of diagnosis and treatment of post-operative combination of acute necrotizing fasciitis and severe septic shock after operation for rectal cancer. Methods Clinical data of 7 patients with combination of acute necrotizing fasciitis and severe septic shock after operation for rectal cancer admitted during January 2013 and December 2015 was retrospectively analyzed. Results The median age of patients was 53 years old, and 3 patients had the history of diabetes, and 3 patients underwent systemic chemotherapy before the operation. Symptoms such as fever, swelling in perinea and groin and pain were found in the 7 patients within 24 h after the operation, and then lactate aci-dosis, system and organ nonfunction and consciousness disorders in different degrees were found within 48 h after the operation. Before debridement, sequential organ failure assessment (SOFA) score was(12. 29 ± 4. 54) score, and acute physiology and chronic health evaluation Ⅱ (Apache Ⅱ) score was(25. 86 ± 9. 70) score, and level of arterial blood lactic acid was 6. 2-23. 0 (13. 59 ± 5. 47) mmol/L. All patients received comprehensively support treatments to keep the function of organs. Among the 7 patients, 1 patient without debridement died on the 3rd d after the rectal surgery because of quickly worse condition, and other 6 patients received surgical debridement within 48-96 h after the onset, and symptoms of shock and acidosis were improved imme-diately. Tissue cultures showed mixed bacterial infections, and pathological examination showed necrotizing fasciitis. Conclu-sion Highly risk factors of postoperative necrotizing fasciitis are complicated with quickly septic shock, lactate acidosis and multiple organ failure in patients with acute necrotizing fasciitis after rectal surgery, diabetes, hypoimmunity and poor prepara-tion before operation, and therefore early diagnosis and surgical debridement is the key to successful treatment.