scholarly journals Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Kenji Okumura ◽  
Tadao Kubota ◽  
Kazuhiro Nishida ◽  
Alan Kawarai Lefor ◽  
Ken Mizokami
Keyword(s):  
Soft Tissues ◽  
Fournier’S Gangrene ◽  
Colostomy Closure ◽  
Anal Stenosis ◽  
Fournier's Gangrene ◽  
Anal Stricture ◽  
Internal Hemorrhoids ◽  
Old Japanese ◽  
History Of ◽  
Diverting Colostomy

Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.

Gangrena de Fournier. Reporte de caso

2020 ◽  
Vol 63 (5) ◽  
pp. 26-30
Author(s):  
Paloma Pérez Ladrón de Guevara ◽  
Georgina Cornelio Rodríguez ◽  
Oscar Quiroz Castro
Keyword(s):  
Mortality Rate ◽  
Necrotizing Fasciitis ◽  
Broad Spectrum ◽  
Soft Tissues ◽  
Fournier’S Gangrene ◽  
Type Ii ◽  
Necrotic Tissue ◽  
Fournier's Gangrene ◽  
Necrotizing Fascitis ◽  
Key Words Fournier's Gangrene

Fournier’s Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics. Key words: Fournier’s gangrene; gangrene; necrotizing fasciitis; infectious necrotizing of soft tissues.

scholarly journals Anoplasty For Fused Anus Following Fournier’s Gangrene Debridement: A Case Report

2021 ◽  
Author(s):  
Jothinathan Muniandy ◽  
Fitjerald Henry ◽  
Yong Sim Teh
Keyword(s):  
Surgical Intervention ◽  
Learning Experience ◽  
Fournier’S Gangrene ◽  
Anal Stenosis ◽  
Success Rates ◽  
Fournier's Gangrene ◽  
Management Options ◽  
Initial Recovery ◽  
Management Challenge ◽  
Surgical Condition

Abstract Anal stenosis is a rare debilitating surgical condition. The severity and level of the impacted region determines the management options. Numerous tension free anoplasty techniques and its varying success rates have been reported. A patient-tailored anoplasty approach depending on the severity, location, and extent of anal stenosis is rudimentary. We present a case of fused anus following extensive surgical debridement for Fournier’s Gangrene. Colonoscopy illumination guided neo-anal creation was performed, which resulted in low severe anal stenosis six weeks later. Subsequently, Y-V anoplasty, lateral internal sphincterotomy, and colostomy closure were done which showed good initial recovery. However, six months later, the anal stenosis recurred, for which diamond-shaped anoplasty was offered but patient had refused any further surgical intervention. The clinical management challenge and learning experience is shared within the report.

scholarly journals Fournier’s gangrene

2016 ◽  
Vol 97 (2) ◽  
pp. 256-261
Author(s):  
A V Prokhorov
Keyword(s):  
Soft Tissues ◽  
Subcutaneous Tissue ◽  
Disease Onset ◽  
Disease Diagnosis ◽  
Fournier’S Gangrene ◽  
Time Interval ◽  
Vacuum Therapy ◽  
Superficial Fascia ◽  
Fournier's Gangrene ◽  
Septic Complications

The review highlights the issues of etiology, pathogenesis, clinical and laboratory picture, radiodiagnosis, treatment and prognosis of fulminant perineum gangrene, or Fournier’s gangrene. According to modern concepts, Fournier’s gangrene is one of the rare forms of necrotizing fasciitis of polymicrobial etiology with a primary lesion of the skin, subcutaneous tissue and superficial fascia of the scrotum, penis, and perineum. Fournier’s gangrene refers to acute surgical diseases of pyonecrotic nature and is characterized by rapid septic course, high mortality, reaching 80%, in spite of the modern antibiotic therapy advances. Over the last decade the Fournier’s gangrene incidence increased in 2.2-6.4 times, due to the increasing number of immunocompromised patients in the population. The disease most often occurs in older men with diabetes, alcoholism and obesity. The Fournier’s gangrene occurrence is preceded by different inflammatory diseases of the colon, urinary organs, scrotum and perineum skin. The disease diagnosis in full-scale stage usually is not difficult. In rare cases, namely in the disease early stages, various radiological methods of investigation, laboratory tests and exploratory surgery with affected soft tissues express biopsy are used with differential diagnosis purposes. The cornerstone in the Fournier’s gangrene treatment is an emergency surgical intervention in combination with a powerful anti-bacterial and anti-shock therapy. To improve the wound healing course and reduce the septic complications risk, new methods of adjuvant treatments such as hyperbaric oxygen therapy and vacuum therapy are used. Hospitalization duration in Fournier’s gangrene is usually lengthy, due to the need to use repeated sanitation necrectomy and reconstructive plastic surgery and are associated with considerable economic costs for treatment. The Fournier’s gangrene prognosis depends on the timing of specialized medical care provision and, above all, on the time interval between the disease onset and surgery performing.

A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 3
Author(s):  
Marco Badinella Martini, MD ◽  
Antonello Iacobucci, MD
Keyword(s):  
Type 2 Diabetes ◽  
Emergency Department ◽  
Alzheimer Disease ◽  
Physical Examination ◽  
Subcutaneous Emphysema ◽  
Vital Signs ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

scholarly journals Fournier’s Gangrene: the Criteria for Diagnosis, Prognostic Factors, Complications and Mortality

2017 ◽  
Vol 10 (2) ◽  
pp. 154-164
Author(s):  
Andrew Vladimirovich Prokhorov
Keyword(s):  
Early Diagnosis ◽  
Soft Tissues ◽  
Laboratory Data ◽  
Scoring Systems ◽  
Fournier’S Gangrene ◽  
Systematic Evaluation ◽  
Fournier's Gangrene ◽  
Early Stages ◽  
Prognostic Criteria ◽  
Complications And Mortality

The early diagnosis, prognosis, complications and mortality Fournier’s gangrene (FG) are discussed. The terms pre-hospital period with FG is amount of 8.0 ± 5.2 days. Cases of misdiagnosis are observed in 70% in the early stages of FG due to nonspecific clinical and laboratory picture, lack of awareness and alertness of doctors. Early diagnosis of FG is based on clinical and laboratory data of the picture. In order to timely diagnosis of FG is used scale laboratory indicators of necrotizing fasciitis (LRINEC), allowing suspect FG in doubtful cases. In diagnostically unclear cases FG used radiation methods. At the slightest suspicion on the FG made explorative operation, including express biopsy of soft tissues. The differential diagnosis is carried out in the early stages of FG with acute diseases anogenital region and is rarely used. As a prognostic criteria discussed the patient's age, the presence and nature of comorbid diseases, severity of the condition, the hospital admission dates, duration of preoperative period, necrosis area, metabolic parameters, the amount of remedial necrectomy, antibiotic regimen, hyperbaric oxygen therapy. For the systematic evaluation of the severity of the patient's condition and prognosis use different scoring systems. Many of the proposed prognostic criteria are controversial. The favorable prognosis in FG is entirely dependent on early diagnosis and timing of emergency surgery. Sepsis and its complications are the main causes of deaths. Mortality in the FG has been a steady downward trend, and is 22.3 ± 8.8%. Prevention of the FG is a timely treatment of infectious and inflammatory diseases of the urinary organs and their complications.

scholarly journals Fournier’S Gangrene Caused byListeria Monocytogenesas the Primary Organism

2015 ◽  
Vol 26 (1) ◽  
pp. 44-46 ◽  
Author(s):  
Sayaka Asahata ◽  
Yuji Hirai ◽  
Yusuke Ainoda ◽  
Takahiro Fujita ◽  
Yumiko Okada ◽  
...  
Keyword(s):  
Tongue Cancer ◽  
Rectal Adenocarcinoma ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Daily Consumption ◽  
Travel History ◽  
Direct Invasion ◽  
History Of ◽  
Raw Fish ◽  
Serotype 4B

A 70-year-old man with a history of tongue cancer presented with Fournier’s gangrene caused byListeria monocytogenesserotype 4b. Surgical debridement revealed undiagnosed rectal adenocarcinoma. The patient did not have an apparent dietary or travel history but reported daily consumption of sashimi (raw fish).Old age and immunodeficiency due to rectal adenocarcinoma may have supported the direct invasion ofL monocytogenesfrom the tumour. The present article describes the first reported case of Fournier’s gangrene caused byL monocytogenes. The authors suggest that raw ready-to-eat seafood consumption be recognized as a risk factor for listeriosis, especially in cases of skin and soft tissue infection.

scholarly journals Coexistence of human immuno deficiency virus, diabetes mellitus, epididymal cysts, and Fournier's gangrene: A case report

2021 ◽  
Vol 38 (4) ◽  
pp. 669-671
Author(s):  
Evrim KAR ◽  
Hatice Şeyma AKÇA ◽  
Serdar ÖZDEMİR ◽  
Abdullah ALGIN ◽  
Serkan Emre EROĞLU
Keyword(s):  
Case Report ◽  
Subcutaneous Tissue ◽  
Fournier’S Gangrene ◽  
Clinical Suspicion ◽  
Perianal Region ◽  
Fournier's Gangrene ◽  
Human Immuno Deficiency Virus ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Artery Disease

Fournier's gangrene (FG) is a form of necrotizing fasciitis that is localized in the external genital organs and perianal region and causes skin and subcutaneous tissue gangrene. The clinical picture may vary depending on the patient's comorbidities and the extent of infection; Many predisposing conditions such as immunodeficiency, diabetes, alcoholism encourage the spread of the infection. In this case report, we highlighted the importance of emergency debridement in patients with multiple comorbidities by presenting the Fournier's Gangrene case in a 57-year-old immunosuppressive male patient with cystic lesions in the epididymis, with a history of hypertension, coronary artery disease, diabetes, HIV (human immunodeficiency virus) and a history of bipolar disorder. The patient, who was operated on for debridement by the urology, was given 1x500mg daptomycin, 3x1g meropenem, 3x450mg clindamycin IV treatment. The patient was discharged with full recovery after 17 days of hospitalization. Clinical suspicion in Fournier's gangrene cases, early surgical debridement, and extended-spectrum anti biotherapy are important. with rapid diagnosis and treatment in patients with improvement can also be seen in patients with comorbidities.

scholarly journals Perforated appendicitis as a source of Fournier’s gangrene in an immunocompetent male

2019 ◽  
Vol 6 (10) ◽  
pp. 3813
Author(s):  
Nasser Alzerwi Alzerwi ◽  
Mohammed Alshanwani ◽  
Afnan Sultan Alsultan ◽  
Sulaiman Almutairi ◽  
Yasser Ibrahim Aldebasi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Perforated Appendicitis ◽  
Rare Condition ◽  
Immunocompetent Patient ◽  
Fournier’S Gangrene ◽  
Critical Importance ◽  
Fournier's Gangrene ◽  
History Of ◽  
Scrotal Swelling

Fournier’s gangrene is a synergetic polymicrobial necrotizing fasciitis of the perianal, perineal and genital areas, it is a rare condition and it has a high mortality rate of up to 67%. Acute appendicitis has been identified as another cause of Fournier’s gangrene. This case demonstrates the critical importance of considering a diagnosis of Fournier’s gangrene because of a missing diagnosis of appendicitis even if the patient is young, healthy, immunocompetent and without a background of abdominal pain. We discuss a case of 35-year-old male, immunocompetent and medically free, who was presented to Emergency Department with a clinical picture of Fournier’s gangrene due to acute perforated appendicitis without a history of abdominal pain, and within 48 hours of the onset of bilateral scrotal swelling. Our case demonstrates the importance of considering Fournier’s gangrene as a complication of an intra-abdominal septic process, even in a young, healthy, immunocompetent patient.

Sign in / Sign up

Export Citation Format

Share Document