直腸癌の穿孔による腰臀部ガス壊疽

・腰部から臀部，大腿にかけて広範囲に生じたガス壊疽を経験した． ・末期大腸癌で余命が短かったことから，手術侵襲の負担を考え、抗菌薬投与のみで治療していた期間があった． ・CT画像にて直腸から臀部筋層内に侵入したガス像を認め，直腸癌の腸管穿孔によるガス壊疽と診断した． （「症例のポイント」より）

Massive gas gangrene secondary to perforated colorectal cancer

Morimura, Sohshi1）Watanabe, Mitsuko1）Takeshima, Kenichiro2）Takahashi, Yutaka3）Sugaya, Makoto1） 1）Department of Dermatology，Ichikawa Hospital，Faculty of Medicine，International University of Health and Welfare 2）Department of Orthopedic Surgery，Ichikawa Hospital，Faculty of Medicine，International University of Health and Welfare, 3）Department of Medical Oncology，Ichikawa Hospital，Faculty of Medicine，International University of Health and Welfare

Abstract An 81-year-old man who had terminal colon cancer with liver and lung metastasis developed a large indurated erythematous plaque with severe pain on the left lumbar and thigh. The X-ray and computed tomography revealed a huge free air from the left iliac crest to the left thigh. He was diagnosed with gas gangrene and treated with antibiotics without surgical debridement due to the poor prognosis of colon cancer. However，due to the liver dysfunction induced by antibiotics，we eventually performed surgical debridement. After the operation，the intestinal perforation was revealed by computed tomography. Thus，he was finally diagnosed with gas gangrene secondary to perforated colorectal cancer.