Search

患者は78歳，女性．2009年5月，頸部違和感，咽頭痛の後，頸部腫大，頸部皮下出血を認め当院紹介となった．入院時検査所見で橋本病と貧血を認めた．血清カルシウム値は正常であった．頸部に圧痛を訴え，CTにて左甲状腺下極の血腫を，造影CTで腫瘤内に血流を認めたが，動脈瘤は認めなかった．上部消化管内視鏡では咽頭喉頭に壁外性の圧排と内出血を認めた．ガリウムシンチにて集積を認めず，腫瘍ではなく甲状腺嚢胞の出血と診断した．入院後絶食し頸部冷却と止血剤投与にて一週間後に手術を施行した．皮下に内出血と甲状腺下極に連続しない内出血した40mm大の嚢腫を認め，左下副甲状腺嚢胞内出血と診断し摘出した．術前血清インタクトPTHの上昇はわずかであったが，内腔穿刺液のインタクトPTHは59,110pg/mlと高値であった．病理組織学的には副甲状腺嚢胞と橋本病であった．副甲状腺嚢胞内出血の自然穿破で頸部皮下出血をきたした患者を経験したので報告する．

Necrotizing fasciitis is relatively rare. We report a case of necrotizing fasciitis secondary to anorectal abscess. A 32-year-old man was admitted to the hospital because of perianal pain. The patinet had had incision and drainage for anorectal abscess on outpatient base at a clinic, but the condition was aggravated. The patient was admitted to the hospital when the seemed very sick and showed oliguria and shock. At the right side of his anus there was seriously gangrenous skin with erosion and subcutaneous hemorrhage. We performed additional incision, drainage and resection of necrotic tissue 11×6cm in size under spinal anesthesia. There was neither purulent discharge nor muscular involvement. After the surgery the patient was transferred to the intensive care unit, because shock and acute renal failure persisted since before surgery and respiratory failure subsequently occurred. Despite our treatment, he died of DIC and MOF three days after admission. Culture yielded Escherichia coli and Bacteroides. We consider that our case was compatible of necrotizing fasciitis. Necrotizing fasciitis is surgical emergency with high mortality rate. Early diagnosis and wide resection of necrotic tissue are very important.