Case report: multidisciplinary treatment of a patient with gas-producing phlegmone.

Abstract

The authors present a 51-year-old patient with a severe case of gas-producing phlegmone following incision of a perianal abscess. Early diagnosis and extensive surgical excision during the first 12 hours from the onset of symptoms are crucial. Treatment of sepsis complicated by multiple organ failure: lung insufficiency (respiratory distress requiring mechanical ventilation), kidney insufficiency (requiring rehydration, furosemid, manitol), circulation (blood derivatives, saline, colloid solutions, cardio tonics, anti-arrhythmic drugs) and liver must be aggressive. Hyperbaric oxygen therapy is essential with repeated identification of aerobic and anaerobic bacteria (hemoculture, tissue sample, wound swab), their sensitivity to antibiotics and repeated surgical debridement of the wound. Following this treatment the patient was transferred to plastic surgery where Thiersh transplants covered skin defects. He survived with an abdominal wall hernia due to a team effort and aggressive multidisciplinary treatment by the general surgeon, anesthesiologist, hyperbaric medicine specialist, microbiologist and plastic surgeon. He refused hernia repair.