Retroperitoneal Necrotizing Fasciitis from Fournier’s Gangrene in an Immunocompromised Patient
18
Citation
29
Reference
10
Related Paper
Citation Trend
Abstract:
Introduction . Necrotizing fasciitis (NF) is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient’s immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV) infection. Case Report . A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. Conclusion . NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.Keywords:
Fournier gangrene
Gangrene
Bilateral Necrotizing Fasciitis around the Hips Differentiated from Fournier Gangrene: A Case Report
As an emergency encountered in orthopedic practice requiring prompt diagnosis and aggressive treatment, necrotizing fasciitis around the hip must be discriminated from Fournier gangrene. The current case report describes a patient who suffered from bilateral type I necrotizing fasciitis around the hips, which was alleviated by prompt surgical debridement and intensive postoperative care.
Fournier gangrene
Surgical debridement
Gangrene
Debridement (dental)
Cite
Citations (0)
Fournier gangrene
Gangrene
Cite
Citations (7)
Fournier's gangrene is a necrotizing fasciitis of the genital and scrotal region due to infectious process. The gangrene is rare. Most cases are diagnosed in elderly patients with immunodeficiency, especially in diabetics or alcoholics. Currently a primary infection focus can be revealed in about 95% cases. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract or skin. Fournier's gangrene is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Early surgical debridement of necrotic tissues and antibiotics are fundamental in the treatment of Fournier's gangrene. Despite of advanced management mortality is still high and averages 20-30%.
Gangrene
Fournier gangrene
Debridement (dental)
Cite
Citations (25)
The aetiology, definition, and management of Fournier's gangrene are an enigma to surgeons and urologists alike. Indeed, controversy surrounds its management. We managed 110 cases of Fournier's gangrene with different modalities and compared their outcomes along with those of contemporary studies.To evaluate aetiology, predisposing factors, and causative organisms plus compare modalities of surgical management of Fournier's gangrene.110 cases of Fournier's gangrene that were admitted and treated in S.S.G. Hospital (Vadodara/Baroda, India) from January 2000 to December 2006 were evaluated.The average duration of symptoms was 3-5 days and the commonest presentation was scrotum swelling plus pain and fever. The most common aetiological factor was trauma and urinary tract infection. The majority (84%) of cases had bilateral scrotal involvement. In the majority (46%) of patients, a mixture of causative organisms were isolated; E. coli was isolated in 17.5% of patients. The fascicutaneous rotation thigh flap procedure gave the best cosmetic results.Review of the cases suggests that the Fournier's gangrene is either an idiopathic condition or secondary to adjacent infection or the operation performed. The condition progresses rapidly but is usually self-limiting and most commonly confined to the genitalia. Adequate diagnosis is imperative and immediate intense and aggressive therapy is necessary. Prompt surgical debridement and administration of appropriate antibiotics (both local and systemic) are necessary to lower mortality and morbidity. Most of the defects can be closed secondarily while some need coverage by skin grafting. Fasciocutaneous rotation thigh flap is the best cosmetically acceptable repair, although it demands surgeons with considerable skill and experience and there are relatively more complications compared with other procedures as well as a longer hospital stay.
Gangrene
Fournier gangrene
Etiology
Groin
Debridement (dental)
Cite
Citations (53)
French venereologist Jean-Alfred Fournier described this gangrene as a fulminant gangrene of the penis and scrotum in young men. He reported five cases in his clinical lectures in 1883 though it was first described by Baurienne in 1764. Fournier’s gangrene is a form of necrotizing fasciitis that affects the genital and surrounding perineal and perianal areas. It’s a life-threatening disease leading to 20 to 80 percent mortality. It destroys tissues quickly and infection progresses to septic shock which kills patient if prompt and aggressive treatment is not started. Common symptoms of Fournier’s gangrene are pain in scrotum and or perineum, redness, fever and weakness. Advanced cases have foul smelling discharge from infected tissues. It is due to polymicrobial infection, both aerobic and anaerobic. Fournier’s gangrene is usually diagnosed clinically but imaging investigations such as X-rays, Ultrasound and CT scan help a lot to reach the diagnosis early. Treatment mainly consists of resuscitation, intravenous antibiotics and debridement. We have treated successfully four cases of advanced Fournier’s gangrene with team work of surgeons, anaesthesiologists, physicians and critical care specialists. Full recovery is possible due to a good team work and understanding the disease.
Gangrene
Fournier gangrene
Fulminant
Work-up
Orchitis
Cite
Citations (0)
Radiologic-Pathologic Conferences of the Massachusetts General Hospital. Necrotizing fasciitis of the scrotum (Fournier's gangrene)C M Fan, G J Whitman and F S ChewAudio Available | Share
Fournier gangrene
Gangrene
Acute scrotum
Cite
Citations (15)
A 57-year-old obese female with uncontrolled diabetes mellitus type I presented to the emergency department (ED) with the main complaint of worsening pain and redness in her right groin and inguinal regions. In the ED, a CT scan confirmed the likely presence of necrotizing fasciitis in the right groin and thigh. She was also found to be febrile and septic on admission. She was urgently taken to the OR for extensive debridement then admitted to the ICU for medical stabilization. She was subsequently taken back for serial debridements, and a negative pressure wound therapy with instillation (NPWTi-d) Veraflo device was placed once the wound was successfully debrided down to viable tissue. This is a case study on the wound progression of this patient.
Negative-pressure wound therapy
Debridement (dental)
Groin
Surgical debridement
Cite
Citations (3)
Objective To analyze the anatomic characteristics of Fournier gangrene and to provide references in clinics.Methods The clinical data of 21 patients with Fournier gangrene from January 1997 to June 2011 were reviewed and discussed combined with literature analysis.Results One(1/21,4.76%) patient was died due to multiple organ failure induced by septicopyemia.Coexisting diabetes mellitus was found in three patients(3/21,14.29%).The infection of Fournier gangrene was extended along the superficial fascia in 17 patients(17/21,80.95%) with 1 patient(1/21,4.76 %) experiencing deep fascia infection.The most commonly found bacteria were streptococcal species,escherichia coli,staphylococcus,bacteroides,clostridium,et al.More than two organisms were cultured in 6 patients(6/21,28.57%).Conclusion Familiarity with the anatomic and path physiological characteristics of Fournier gangrene is important in the diagnosis and treatment of Fournier gangrene.
Fournier gangrene
Gangrene
Deep fascia
Gas gangrene
Cite
Citations (0)
We report a 66 year-old Japanese man with Fournier's gangrene developed from pressure ulcers. Pelvic computed tomography (CT) scan confirmed subcutaneous gas accumulation from the scrotum to the gluteal region. Emergent debridment and the administration of systemic antibiotics improved the symptoms. Fournier's gangrene is a necrotizing fasciitis of the perineal and genital region. Proper treatment for bacterial infection in pressure ulcers is critical and clinicians should be alert to early signs of necrotizing fasciitis.
Gangrene
Fournier gangrene
Gas gangrene
Negative-pressure wound therapy
Sex organ
Cite
Citations (0)
Fournier gangrene
Gangrene
Presentation (obstetrics)
Deep fascia
Cite
Citations (70)