Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

Ioannis Papaconstantinou,Irini Grapsa,Anneza I Yiallourou,Dionysios Voros,George Polymeneas,Nicolaos Dafnios

doi:10.1155/2011/702429

Ioannis Papaconstantinou, Irini Grapsa + Show 4 more

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https://doi.org/10.1155/2011/702429

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Abstract

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

Highlights

Fournier’s gangrene (FG) is a rare, synergistic, fulminant form of necrotizing fasciitis involving the genital, perineal, and perianal regions [1]
FG is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical and urological emergency [1]
We present a case of Fournier’s gangrene following a perianal abscess which was successfully treated in our department despite the severity of the patient’s condition

Summary

Introduction

Fournier’s gangrene (FG) is a rare, synergistic, fulminant form of necrotizing fasciitis involving the genital, perineal, and perianal regions [1]. FG is defined as a potentially fatal condition, affecting any age and gender, which results in thrombosis of small vessels, obliterative endarteritis, and eventually skin and tissue necrosis [2]. In the majority of cases, aerobic and anaerobic bacteria are synergistically involved as a result of anorectal and urogenital trauma and/or infection. FG is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical and urological emergency [1]. The keystones of management are hemodynamic stabilization, effective antibiotic treatment, and urgent aggressive surgical debridement. We present a case of Fournier’s gangrene following a perianal abscess which was successfully treated in our department despite the severity of the patient’s condition

Case Presentation

Discussion

Conclusions