Fournier's Gangrene Following Enema Administration: Report of Five Cases

Abstract

Background: The use of enemas is safe and common in the treatment of chronic constipation, especially in the elderly. Fournier's gangrene following enema administration has not previously been described. Methods: We reviewed 41 patients with a diagnosis of Fournier's gangrene admitted to our hospital between June 1999 and June 2004. Data on the age, gender, time interval between administration of an enema and appearance of symptoms, enema preparations, comorbid conditions, clinical symptoms, bacteriologic findings, treatment, hospital stay, and outcome were all retrospectively analyzed. Results: Five patients were treated by our surgical service because of Fournier's gangrene following previous administration of an enema. All of these patients were male with diabetes, and were aged from 67 to 77 (mean, 72.4) years. They were asymptomatic before the enema procedures. The relevant time from application of the enema was from 1 to 5 days before the patients' began to show symptoms. One patient had a rectal perforation caused by a disposable enema. All of them were treated with broad-spectrum antibiotics and aggressive debridement. Three patients underwent a colostomy, and 1 had a suprapubic cystostomy. Four patients recovered and 1 died. Conclusions: All patients with a fever and a history of enema use, especially the elderly with diabetes, should have a thorough physical examination to identify potential anorectal sources of infection. Once Fournier's gangrene is recognized, aggressive fluid resuscitation should be begun and broad-spectrum antibiotics administered. Immediate surgical consultation for aggressive debridement is required.