A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy
Abstract Background Necrotizing fasciitis after pancreaticoduodenectomy (PD) has never been reported. We experienced a case of necrotizing fasciitis caused by pseudoaneurysmal hemorrhage after PD. Case presentation A 72-year-old male was diagnosed with cholangiocarcinoma and underwent PD. Bile leaka...
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Japan Surgical Society
2022-04-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01418-5 |
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| author | Lulu Li Kyohei Abe Tomoyoshi Okamoto Michinori Matsumoto Yasuro Futagawa Masaru Kanehira Toru Ikegami |
| author_facet | Lulu Li Kyohei Abe Tomoyoshi Okamoto Michinori Matsumoto Yasuro Futagawa Masaru Kanehira Toru Ikegami |
| author_sort | Lulu Li |
| collection | DOAJ |
| description | Abstract Background Necrotizing fasciitis after pancreaticoduodenectomy (PD) has never been reported. We experienced a case of necrotizing fasciitis caused by pseudoaneurysmal hemorrhage after PD. Case presentation A 72-year-old male was diagnosed with cholangiocarcinoma and underwent PD. Bile leakage was detected postoperatively, conservatively resolved, and the patient was discharged on the 36th day after surgery. On the 42nd day after surgery, a pseudoaneurysm of the gastroduodenal artery ruptured. Transcatheter arterial embolization was performed for hemostasis: however, a large intra-abdominal abscess caused by an infected hematoma was recognized. On the 57th day after surgery, the patient developed necrotizing fasciitis. He underwent debridement with skin reconstruction using a latissimus dorsi flap and skin transplantation. Costochondritis and liver metastasis were detected on the 267th day after surgery. Infection was controlled by rib cartilage resection, debridement, and negative pressure wound therapy. Chemotherapy involving gemcitabine and cisplatin was initiated on the 460th day after the initial surgery with a partial response (PR) and was continued for more than one year. Conclusions We herein reported a rare case of necrotizing fasciitis following hematoma infection after PD that was treated using multidisciplinary therapy with PR following chemotherapy. |
| format | Article |
| id | doaj-art-e17c5b2dca444687bfa0d34257cd0d7a |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-04-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-e17c5b2dca444687bfa0d34257cd0d7a2025-08-20T03:19:07ZengJapan Surgical SocietySurgical Case Reports2198-77932022-04-01811610.1186/s40792-022-01418-5A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomyLulu Li0Kyohei Abe1Tomoyoshi Okamoto2Michinori Matsumoto3Yasuro Futagawa4Masaru Kanehira5Toru Ikegami6Department of Surgery, The Jikei University School of MedicineDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDepartment of Surgery, The Jikei University Daisan HospitalDivision of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of MedicineAbstract Background Necrotizing fasciitis after pancreaticoduodenectomy (PD) has never been reported. We experienced a case of necrotizing fasciitis caused by pseudoaneurysmal hemorrhage after PD. Case presentation A 72-year-old male was diagnosed with cholangiocarcinoma and underwent PD. Bile leakage was detected postoperatively, conservatively resolved, and the patient was discharged on the 36th day after surgery. On the 42nd day after surgery, a pseudoaneurysm of the gastroduodenal artery ruptured. Transcatheter arterial embolization was performed for hemostasis: however, a large intra-abdominal abscess caused by an infected hematoma was recognized. On the 57th day after surgery, the patient developed necrotizing fasciitis. He underwent debridement with skin reconstruction using a latissimus dorsi flap and skin transplantation. Costochondritis and liver metastasis were detected on the 267th day after surgery. Infection was controlled by rib cartilage resection, debridement, and negative pressure wound therapy. Chemotherapy involving gemcitabine and cisplatin was initiated on the 460th day after the initial surgery with a partial response (PR) and was continued for more than one year. Conclusions We herein reported a rare case of necrotizing fasciitis following hematoma infection after PD that was treated using multidisciplinary therapy with PR following chemotherapy.https://doi.org/10.1186/s40792-022-01418-5CholangiocarcinomaPancreaticoduodenectomyNecrotizing fasciitisChemotherapy |
| spellingShingle | Lulu Li Kyohei Abe Tomoyoshi Okamoto Michinori Matsumoto Yasuro Futagawa Masaru Kanehira Toru Ikegami A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy Surgical Case Reports Cholangiocarcinoma Pancreaticoduodenectomy Necrotizing fasciitis Chemotherapy |
| title | A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy |
| title_full | A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy |
| title_fullStr | A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy |
| title_full_unstemmed | A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy |
| title_short | A rare case of pseudoaneurysmal hemorrhage, necrotizing fasciitis, and costochondritis after pancreaticoduodenectomy |
| title_sort | rare case of pseudoaneurysmal hemorrhage necrotizing fasciitis and costochondritis after pancreaticoduodenectomy |
| topic | Cholangiocarcinoma Pancreaticoduodenectomy Necrotizing fasciitis Chemotherapy |
| url | https://doi.org/10.1186/s40792-022-01418-5 |
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