The diagnosis of retroperitoneal necrotizing fasciitis is divided into two parts, one is "retroperitoneal" and the other is "necrotizing fasciitis".

The retroperitoneum indicates where the disease occurs. This area refers to a large loose area between the peritoneum and the posterior peritoneum below the diaphragm, above the pelvic diaphragm—the levator ani muscle, the coccygeus muscle, and the supradiaphragmatic fascia and subpelvic fascia that cover both muscles. Due to the loose structure and special location of this area, many vital organs and blood vessels and nerves pass through.

It is precisely because of the loose structure and strong extensibility of this area that infection, bleeding or tumor development here is usually more severe. The physical properties of human tissues themselves are to a certain extent helpful in stopping bleeding and fighting infection.

Necrotizing fasciitis illustrates the severity of the disease. As a critical and severe multibacterial mixed infection, necrotizing fasciitis can be fatal in any setting.

If necrotizing fasciitis occurs in an area of the body, diagnosis is relatively undifficult. Patients may have significant pain and redness, warmth, or whitening and edema. In general, it will exhibit features similar to diffuse cellulitis.

However, necrotizing fasciitis will then develop rapidly, and with the attack of germs and inflammatory substances, the patient's early severe pain will be reduced or even completely disappeared due to the death of the affected nerves, and will be replaced by numbness or paralysis. This is also one of the main features of necrotizing fasciitis.

As blood vessels are destroyed and blood vessels embolize, the skin gradually begins to turn purple and black, and blisters containing bloody fluid appear.

As the germs further erode the body, the subcutaneous fat and fascia eventually liquefied and necrosis, oozing a foul-smelling exudate and producing subcutaneous gas. At this point, the patient will also have symptoms of systemic poisoning. This is sepsis.

According to the results of the analysis of the old thing, Qian Aiwu is now in the last step. She already had subcutaneous gas on her CT scan and symptoms of sepsis.

"Yes, contact the gastrointestinal surgery department immediately and ask them to prepare for surgery immediately. Sun Lien hung up the phone, his tone was so hurried that he changed his voice a little, "Then contact the infectious disease department and the ICU to prepare for consultation......" He said as he looked at Qian Aiwu. Qian Aiwu, who had just been injected with meperidine hydrochloride and was not very conscious, raised his eyelids and glanced at Sun Lien, then closed his eyes and fell asleep.

Seeing this, Sun Lien was in a hurry, and directly turned his head and shouted outside the inpatient ward, "Push the gurney over and call the operating ladder up, quickly!"

Brune was frightened by Sun Lien's violent reaction, "What's wrong with this person?"

"This person is going to die!" Sun Lien shouted out directly in his heart in a hurry, "She is retroperitoneal necrotizing fasciitis!"

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This is the first time that Sun Lien has taken the initiative to send a patient into the operating room. Because it was a sudden emergency operation, the entire operating room did not have the usual sense of calmness. Every medical worker ran around as if they were in a race against death. Instrument nurses are urgently preparing surgical equipment, and plasma urgently transferred from the blood bank is also being stuffed into the rebalancer. Sun Lien changed into a surgical gown and was nervously communicating with the chief surgeon on the side about the patient's condition.

"I still can't see it on CT. The surgeon looked at the CT image on the monitor and frowned. "Dr. Sun, are you sure it's retroperitoneal necrotizing fasciitis?"

Where can Sun Lien confirm it? At this time, the diagnosis of the old thing is as much a secret as the status bar of the house. He could only explain, "I asked Dean Wu to ask an expert to see the image, and the judgment is very reliable." And her symptoms do fit. ”

The surgeon thought for a moment and cautiously proposed, "Otherwise, I'd better use a laparoscope to take a look at it first, and if there are signs of fasciitis, then turn to laparotomy." ”

Sun Lien nodded, this is a safer method. The risk of repeating laparotomy in a patient who has just undergone uterine and adnexal removal is very high. It would be nice to be sure that there is necrotizing fasciitis, but it is a bit unreasonable to perform an open surgery on a patient based on a single CT image that neither the surgeon nor the radiologist at our hospital can determine.

If it weren't for the scary fact of knowing that Sun Lien's diagnosis was accurate, if it weren't for knowing that this patient was handed over to Sun Lien by Vice President Liu. The chief surgeon of the gastrointestinal surgeon would not agree to Sun Lien's request like this.

The laparoscope quickly passed through Qian Aiwu's flank and penetrated retroperitoneally. Soon, her intestines were revealed on the screen in the operating room, as well as the peritoneum behind the intestines.

"There is obvious intestinal edema......" Before the chief surgeon could finish his words, a black fascia appeared on the screen. Even an emergency physician like Sun Lien can see that this is a very obvious and serious necrotic lesion.

"Turn your belly. After about 10 minutes of laparoscopic observation in silence, the surgeon decided to switch to laparotomy. "This infected area is too large. ”

For patients with this extensive necrotizing fasciitis, aggressive and adequate drainage and combination therapy with multiple antibiotics to cope with possible multibacterial co-infection are very important treatment strategies. For the antibiotic part, Sun Lien is going to discuss it with the licensed pharmacists in the pharmacy department and the professional doctors in the infectious disease department, and what he can do at present is mainly to watch the operation be completed first, and then give Qian Aiwu dialysis treatment - if necessary, he may even need to perform plasma exchange.

There are treatment methods, but none of them can guarantee that Qian Aiwu will be able to carry it. All the doctors can do is try to give her the most appropriate treatment and see if she can resist it.

"Try to drain as much as possible. Seeing that there was nothing he could do here, Sun Lien and the chief surgeon exchanged a few more words, and then turned around and left the operating room - Director Han and the licensed pharmacist had arrived in the small conference room of the emergency room five minutes ago. If he didn't hurry up, it would be a bit too much to say.

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"At present, the culture results are not available, and it is possible to continue the treatment with imipenem cilastatin sodium. After discussing with each other for a while, the two licensed pharmacists who arrived with Director Han gave their professional advice, "If hemodialysis or plasma exchange is required, the concentration of antibiotics in the blood will decrease, and the specific proportion of the decrease needs to be calculated separately according to the amount of replacement." If you are planning to undergo this treatment, please say hello to us in advance, and we will report to you the dosage of the medication that should be refilled as soon as possible. ”

Practising pharmacists are actually a very useful ancillary profession. If they were asked to calculate the amount of antibiotic supplements after dialysis or plasma exchange, they would either come to the wrong conclusion after a long period of calculations, or they would not have calculated at all at all - rather than risk overdose or underdose, it would be better to perform dialysis and replacement first, and then refill the antibiotics. But this will inevitably lead to Qian Aiwu's infection being suppressed by medication for a few hours on dialysis. The risk caused by the drug is replaced by the risk of infection.

Sun Lien nodded and began to wonder whether to dig two licensed pharmacists into the comprehensive diagnosis center. On the other hand, the infectious disease department has given a more aggressive treatment plan.

"We recommend closed continuous irrigation drainage for the patient. "Although this treatment is mainly used for superficial necrotizing fasciitis, we think that this treatment will also work for patients with retroperitoneal necrotizing fasciitis - a large amount of hydrogen peroxide and saline irrigation is even better than VSD." ”