输卵管癌术后化疗合并产气荚膜梭菌脓毒症1例

Clostridium perfringens sepsis after chemotherapy in a patient with carcinoma of fallopian tube

患者,50岁,因输卵管恶性肿瘤术后2个月,发热伴腹痛1 d入院。2个月前因输卵管恶性肿瘤行腹腔镜下输卵管恶性肿瘤分期术,术后定期化疗。1 d前自诉进食外买熟鸡肉后出现发热,体温最高39.4℃,伴左下腹及臀部疼痛,排水样便,里急后重,恶心,呕吐,强迫侧卧位。于急诊查血常规:WBC 16×10^9/L,NUT 14.48×10^9/L,Hb 106 g/L;肝功能:ALT 127 U/L,AST 89 U/L,TBil 12.41μmol/L,DBil 3.27μmol/L,IBil 9.14μmol/L;CRP 8.75 mg/L,降钙素原(PCT)0.142 ng/ml。予依替米星静脉滴注后症状无缓解,左下腹痛迅速扩散至全腹,以脐周为著,遂收入院。入院查体全腹肌紧张,有压痛、反跳痛,肠鸣音3~5次/min。