TITLE:
Necrotizing Fasciitis Secondary to Emphysematous Cholecystitis and Cholecystocutaneous Fistula: A Rare Case Report Presentation
AUTHORS:
Alexandra N. Dominianni, Samantha A. Delapena, Luis G. Fernandez, Mostaffa T. Jabassini, Sean F. O’Keefe, Rachel L. Villanueva, Marc R. Matthews
KEYWORDS:
Emphysematous Cholecystitis, Gangrenous Cholecystitis, Cholecystocutaneous Fistula, Necrotizing Fasciitis, Sepsis
JOURNAL NAME:
Surgical Science,
Vol.14 No.5,
May
31,
2023
ABSTRACT: Emphysematous
cholecystitis is a rare subtype of acute cholecystitis characterized 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 cholecystitis. The
subsequent development of a cholecystocutaneous fistula, an abnormal
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.