Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2021; 9(28): 8537-8544
Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8537
Necrotizing fasciitis of cryptoglandular infection treated with multiple incisions and thread-dragging therapy: A case report
Xiao-Chun Tao, De-Chang Hu, Li-Xin Yin, Chen Wang, Jin-Gen Lu
Xiao-Chun Tao, De-Chang Hu, Li-Xin Yin, Chen Wang, Jin-Gen Lu, Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Author contributions: Tao XC and Hu DC performed the operation; Yin LX and Wang C assisted in the follow-up treatment; Tao XC wrote the initial draft of the article; Wang C and Lu JG reviewed and edited the article; All authors actively reviewed and revised the manuscript and approved the finally submitted manuscript.
Supported by the Young Talent Program of LongHua Hospital Shanghai University of Traditional Chinese Medicine, No. RC-2019-01-01; and the Shanghai Three-year Action Plan of Further Accelerated Development in Traditional Chinese Medicine, No. ZY (2018-2020)-CCCX-1007.
Informed consent statement: The patient provided the consent form to give his consent for materials in the report to appear in academic journals and associated publications.
Conflict-of-interest statement: All the authors declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chen Wang, MD, Surgeon, Department of Anorectal, LongHua Hospital Shanghai University of Traditional Chinese Medicine, No. 725 South Wanping Road, Shanghai 200032, China. wangchen_longhua@163.com
Received: May 6, 2021
Peer-review started: May 6, 2021
First decision: June 6, 2021
Revised: June 19, 2021
Accepted: August 6, 2021
Article in press: August 6, 2021
Published online: October 6, 2021
Processing time: 144 Days and 23.7 Hours
Abstract
BACKGROUND

Necrotizing fasciitis is a fulminant necrotizing soft tissue disease with a high fatality rate. It always starts with impact on the deep fascia rapidly and might result in secondary necrosis of the subcutaneous tissue, fascia, and muscle. Thus, timely and multiple surgical operations are needed for the treatment. Meanwhile, the damage of skin and soft tissue caused by multiple surgical operations may require dermatoplasty and other treatments as a consequence.

CASE SUMMARY

Here, we report a case of 50-year-old male patient who was admitted to our hospital with symptoms of necrotizing fasciitis caused by cryptoglandular infection in the perianal and perineal region. The symptoms of necrotizing fasciitis, also known as the cardinal features, include hyperpyrexia, excruciatingly painful lesions, demonstration gas in the tissue, an obnoxious foul odor and uroschesis. The results of postoperative pathology met the diagnosis. Based on the premise of complete debridement, multiple incisions combined with thread-dragging therapy (a traditional Chinese medicine therapy) and intensive supportive therapies including comprising antibiotics, nutrition and fluids were given. The outcome of the treatment was satisfactory. The patient recovered quickly and achieved ideal anal function and morphology.

CONCLUSION

Timely and effective debridement and multiple incisions combined with thread-dragging therapy are an integrated treatment for necrotizing fasciitis.

Keywords: Necrotizing fasciitis; Cryptoglandular infection; Traditional Chinese medicine; Multiple incisions and thread-dragging therapy; Integrated treatment; Case report

Core Tip: Necrotizing fasciitis is a fulminant necrotizing soft tissue disease, which usually progress quickly with a high fatality rate. A basic treatment is timely and thorough debridement. However, an extensive debridement may cause bleeding, nutritional deterioration, or even ends up with dermatoplasty. Here, we report a patient diagnosed with perianal and perineal necrotizing fasciitis. The main treatment is multiple incisions combined with thread-dragging therapy, a common traditional Chinese medicine surgery that usually results in rapid recovery and a low chance of subsequent dermatoplasty. The patient was fully cured and discharged with satisfaction of the treatment.