Abstract
We present the case of an eighty-two-year-old man who presented with testicular pain, diarrhoea, fresh rectal bleeding, and weight loss. A clear history was not obtained because of presumed chronic confusion secondary to age related vascular dementia. He was subsequently diagnosed with Fournier’s gangrene and a retrospective obtainment of his collateral history revealed a completely normal pre-morbid cognitive level of function. Thus, his confusion was secondary to an atypical cause of sepsis and he was managed with surgical debridement. We highlight the value of urgent computed tomography (CT) scanning as well as the use of screening tools for assessing cognitive function, particularly in surgical specialties, as well as the importance of obtaining a collateral history and discussing means for better collaborative efforts amongst surgeons and physicians in managing the “confused patient”.
Highlights
Fournier’s gangrene is an infection normally characterised by the mixture of aerobic and anaerobic microorganisms resulting in necrosis of fascia layers around the perineal skin and genital areas [1]
We present a case of a patient who had immediate symptoms of Fournier’s gangrene with a history suggestive of rectal cancer symptoms
We discuss how his treatment was nearly delayed because his confusion was initially wrongly attributed to a dementia-process, and the value of early computer tomography (CT) scanning to both aid the diagnosis as well as for preoperative planning
Summary
Fournier’s gangrene is an infection normally characterised by the mixture of aerobic and anaerobic microorganisms resulting in necrosis of fascia layers around the perineal skin and genital areas [1]. It is a progressive process and can be fatal if not treated promptly [2]. We present a case of a patient who had immediate symptoms of Fournier’s gangrene with a history suggestive of rectal cancer symptoms We discuss how his treatment was nearly delayed because his confusion was initially wrongly attributed to a dementia-process, and the value of early computer tomography (CT) scanning to both aid the diagnosis as well as for preoperative planning
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