Patient L.V. L (17 years old, Cao Bang) developed an acne blister in the buttock area about a month before being admitted to the hospital. Thinking this was just a normal teenage acne, the patient did not go for examination, did not receive treatment, and also did not pay attention to hygiene and care for the damaged area.
About 4 days before being admitted to the hospital, the patient began to feel tired, cough a lot, expectorant phlegm, and gradually increased shortness of breath. On the day of admission, the patient had severe shortness of breath, chest tightness, cyanosis, and drowsiness. The family took the patient to a lower-level hospital in a state of high fever of 38.8°C, rapid heartbeat, unobserved rotational pulse, and poor lung ventilation.
Here, the patient was diagnosed with septic shock, severe pneumonia, multiple organ failure, blood clotting disorder and electrolyte disorder. The patient had to have an endotracheal tube inserted with a ventilator and was urgently transferred to the National Hospital for Tropical Diseases.
At the Intensive Care Center, the patient was admitted to the hospital in a state of severe septic shock, requiring mechanical ventilation, high-dose vasopressors and continuous blood pressure monitoring through a central venous catheter.
Chest CT results showed that the two lungs had many abscesses, accompanied by pneumothorax and pleural effusion on both sides. Resonance from the thigh-buttock area recorded many extensive abscesses in the subcutaneous soft tissue of the coccyx and the entire buttock muscle mass on both sides.
Doctors quickly drained the pleural media on both sides, sucked out a large amount of yellow-brown pus, and at the same time indicated surgery to remove the necrotic area. The results determined that the patient had septic shock due to drug-resistant Staphylococcus aureus (MRSA), lung abscess, buttock abscess with pneumothorax, pleural pus - very severe prognosis.
According to Dr. Le Thi Huyen, National Hospital for Tropical Diseases, boils in the buttocks that exist for a long time but are not treated have become an initial infection site. Because they are located in a discreet location, the lesions silently spread deep into soft tissues, causing skin and muscle necrosis, revealing tendons and bones in the buttocks. Bacteria from the abscess invade the blood causing sepsis, and at the same time create metastases in the lungs, leading to pulmonary abscesses and multiple organ failure.
The patient was actively resuscitated, infection controlled, pus drainage on both lungs and blood clotting disorders adjusted. After treatment, the respiratory condition gradually improved, oxygen demand decreased, but lung damage was still severe and close monitoring was needed.
Regarding the buttock - cullete area with severe necrosis, the patient had to undergo many surgeries to remove dead tissue, puncture and aspirate pus and place a negative pressure aspiration system (VAC) to clean the wound. After 3 weeks of treatment, the entire necrotic tissue was removed, granular tissue began to recover, but the soft tissue defect area reached about 60% of the buttock area, and the buttock muscles were almost completely atrophied.
Doctor Nguyen Ngoc Linh, Department of Plastic Surgery and Interdisciplinary Surgery, said: Patients with prolonged resuscitation are very likely to have spleen ulcers pressing on the coccyx region. This is a region that is often wet, easily contaminated by contact with excretory fluids, creating conditions for bacteria to penetrate directly into the blood, making the infection worse.
After 2 weeks of plastic surgery, the patient was able to sit up, the wound was almost completely healed, is practicing rehabilitation and is expected to be discharged from the hospital in the near future.
