Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation
- 1 College of Medicine-Phoenix, University of Arizona, Phoenix, AZ, USA
- 2 Creighton University Arizona Health Education Alliance, Phoenix, AZ, USA
- 3 Department of Surgery, Division of Trauma Surgery/Surgical Critical Care, The University of Texas Health Science Center, Tyler, TX, USA
- 4 Surgical Resident, Abrazo Health Network General Surgery Residency, Glendale, AZ, USA
- 5 Area Sales Manager, Miach Orthopedics
- 6 Surgical Acute Account Manager, 3M, Minneapolis, MN, USA
- 7 Clinical Professor of Surgery, Banner University of Arizona/University Medical Center, Tucson, AZ, USA
- 8 The University of Texas-Tyler School of Medicine Bill Barrett Endowed Chair in Trauma Surgery, Tyler, TX, USA
- 9 Trauma Wound Care, UT Health East, Tyler, TX, USA
- 10 Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
- 11 Adjunct Clinical Professor of Medicine and Nursing, University of Texas, Arlington, TX, USA
- 12 Past Commanding General TXSG Medical Brigade, Austin, TX, USA
Abstract
Emphysematous cholecystitis is a rare subtype of acute cholecystitis characte rized by the presence of gas in the gallbladder wall secondary to ischemia . Typically, this is a result of cystic artery vascular compromise with a concomitant infection from gas-forming organisms such as Clostridium species, Klebsiella species, or Escherichia coli . The mortality rate of acute emphysematous cholecystitis is 15 % - 20% compared with 1.4% in uncomplicated acute cholecys titis. The subsequent development of a cholecystocutaneous fistula, an ab normal connection between the gallbladder and the skin, is also a rare complication of gallbladder disease. We describe a case of a 77-year-old male who presented with right flank necrotizing fasciitis which developed from a cholecystocutaneous fistula secondary to emphysematous cholecystitis. Once the necrotic tissues were adequately debrided, the large open wound was treated with negative pressure wound therapy with instillation (NPWT-i) utilizing hypochlorous acid (HOCL). The wound was closed with a split - thickness skin graft.
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