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首页> 外文期刊>Cureus. >Subacute Peristomal Necrotizing Fasciitis Detected During Adjuvant Chemotherapy for Adenocarcinoma Rectum: Case Report on a Unique Presentation and Description of a Simple Surgical Strategy for Treatment
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Subacute Peristomal Necrotizing Fasciitis Detected During Adjuvant Chemotherapy for Adenocarcinoma Rectum: Case Report on a Unique Presentation and Description of a Simple Surgical Strategy for Treatment

机译：腺癌直肠辅助化疗期间检测到的亚急性Pecromal坏死性筋膜炎：独特的介绍和简单的治疗策略的描述的病例报告。

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Necrotizing fasciitis (NF) is a rare entity with its subacute form being even rarer. The?condition has also been described to occur in the peristomal area in relation?to different clinical scenarios. However, it has not been described in the setting of adjuvant chemotherapy where these medications have already been given. While the?diagnosis may be delayed or missed due to the subtle symptomatology of the indolent subacute form of NF, another reason for a delayed or missed diagnosis may be the excessive use of tape and the stoma belt around the stomal appliance?to prolong the life of the appliance beyond its recommended days of usage due to economic constraints. This,?in turn, covers a larger area around the peristomal skin?and developing skin changes associated with necrotizing fasciitis. Despite the less aggressive presentation of the subacute form, it may still represent a unique surgical challenge in this setting, as the chemotherapy-induced neutropenia bound to occur a few days after the chemotherapy may expose the patient to serious complications at that time. As such, the surgical plan at the time of presentation may become the determinant of morbidity and mortality. Here, a case is presented of a young patient who underwent abdominoperineal resection for stage III adenocarcinoma of the rectum. He was referred to us on the day of the fourth cycle of adjuvant chemotherapy by the oncology service where he had received part of his chemotherapy regimen. On presentation, he was found to be having significant skin changes in the peristomal area consistent with necrotizing fasciitis despite being clinically stable.?The authors present this unique case as a study from which many lessons can be learned. They also?explain the thought process behind a well-planned?but simple surgical strategy that was implemented with a?successful patient outcome. In addition to describing this surgical strategy, the case report is concluded by highlighting some factors that may raise suspicion of this condition?and by emphasizing routine history-taking for peristomal symptomatology and a thorough examination of the peristomal site prior to administration of chemotherapy in patients with stomata, as this condition, if overlooked, may lead to a fatal outcome.
机译：坏死性筋膜炎（NF）是一种罕见的实体，其亚急性形式更为罕见。还已经描述了与不同的临床情况有关的情况在角膜周围区域发生。然而，尚未在已经给予这些药物的辅助化疗中进行描述。尽管由于惰性的急性亚急性形式的细微症状，诊断可能会延迟或漏诊，但延迟或漏诊的另一个原因可能是过多使用胶带和造口器具周围的造口带以延长寿命。由于经济限制，本产品的建议使用天数超出了建议的使用期限。反过来，这又覆盖了周围皮肤周围的较大区域，并且与坏死性筋膜炎相关的皮肤变化正在发展。尽管亚急性形式的侵袭性较弱，但在这种情况下它仍可能代表着独特的外科手术挑战，因为化疗诱导的中性粒细胞减少症必然会在化疗后几天发生，这可能会使患者当时面临严重的并发症。因此，出现时的手术计划可能成为发病率和死亡率的决定因素。在此，介绍了一位因腹部III期直肠腺癌行腹部手术切除的年轻患者的病例。在肿瘤辅助治疗的第四个周期的那天，他被转介给我们，他接受了部分化疗方案。在介绍时，尽管临床稳定，但发现他的皮膜周围区域皮肤明显改变，与坏死性筋膜炎一致。作者介绍了这一独特病例，作为一项可从中汲取许多教训的研究。他们还解释了计划周全但简单的手术策略背后的思想过程，该策略在患者成功实施后得以实施。除了描述这种手术策略外，该病例报告的结论还在于突出了一些可能引起这种状况怀疑的因素，并强调了常规的病史记录以及有关在接受化疗之前对患者的皮膜周围部位进行彻底检查气孔，因为如果忽略这种情况，可能会导致致命的后果。

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