Abstract
BackgroundFournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks. Emergency surgical debridement of necrotic tissue is crucial, and secondary surgery to resect tumors is necessary for wound healing. However, pelvic exenteration damages the pelvic floor, increasing the likelihood of herniation of internal organs into the infectious wound. The management of pelvic exenteration for rectal cancer with Fournier gangrene has not yet been established. We herein describe the use of a fascia lata free flap in pelvic exenteration for rectal cancer with Fournier gangrene.Case presentationA 66-year-old male who had undergone colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy was referred to our hospital for Fournier gangrene resulting from chemotherapy. Emergency surgical debridement was performed, and the infectious wound around the rectal cancer was treated with intravenous antibiotic agents postoperatively. However, the tumor was exposed by the wound, and exudate persisted. Pelvic exenteration was performed due to tumor infiltration into the bladder and prostate. Tumor resection resulted in a defect in the pelvic floor. A fascia lata free flap (15 × 9 cm) obtained from the left thigh was fixed to the edge of the peritoneum and ileal conduit to close the defect in the pelvic floor and prevent small bowel herniation into the resected space. There was no intraabdominal inflammation or bowel obstruction postoperatively, and outpatient chemotherapy was continued.ConclusionsSurgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer.
Highlights
BackgroundProsthetic material is contraindicated for infected or contaminated abdominal wall defects; the repair of such defects is challenging [1, 2]
Fournier gangrene due to advanced rectal cancer is a rapidly progressive gangrene of the perineum and buttocks
Surgical repair with a fascia lata free flap to close the defect in the pelvic floor led to a good clinical outcome for pelvic exenteration in a patient with Fournier gangrene due to advanced rectal cancer
Summary
Prosthetic material is contraindicated for infected or contaminated abdominal wall defects; the repair of such defects is challenging [1, 2]. We describe the application of a fascia lata free flap to prevent internal organs herniating into the infectious wound following pelvic exenteration for Fournier gangrene due to advanced rectal cancer. Case presentation A 66-year-old male underwent colostomy for large bowel obstruction due to advanced rectal cancer and continued chemotherapy. Emergency surgical debridement was performed on the areas of the perineum and buttocks surrounding the rectal cancer (Fig. 2). Tumor resection was considered necessary to treat the infectious wound, and radical surgery was performed on day 15 after debridement surgery. After the rectum was resected, the pelvic space was left and the perineal wound was not sutured. Positron emission tomography performed 1.5 years postoperatively showed no accumulation of 18F-fluoro-deoxy-glucose in the pelvic area. The patient has had no further complications in 2 years of follow-up
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