| A 10-year-old boy presenting with steroid resistant nephrotic syndrome developed fournier gangrene of the scrotum. Antimicrobial drug therapy, intravenous albumin, excision of necrotic scrotum and left orchidectomy followed by skin grafting 3 weeks later led to an excellent cosmetic and medical result. Six months later he remains nephrotic on diuretic and angiotensin converting enzyme inhibitor medication. ( info) |
| An unusual case of Fournier's gangrene after hemorrhoidectomy and drug-induced agranulocytosis, as the predisposing condition, is described. The patient had severe granulocytopenia that was attributed to the recent use of dipyrone. Together with hemodynamic resuscitation, broad-spectrum antibiotic and recombinant human granulocyte colony-stimulating factor were started. Wide surgical excision of all the gangrenous tissues, in addition to laparoscopic formation of a defunctioning sigmoid loop colostomy, was performed. The white blood cell count rose steadily and the patient experienced a rapid recovery. We emphasize that radical surgery must be accompanied by pharmacologic interventions for a successful outcome in such cases. ( info) |
3/65. Necrotising fasciitis in a hiv positive male: an unusual indication for abdomino-perineal resection. We report a case of necrotising fasciitis of the genitoperineum (Fournier's gangrene) in a hiv positive male following incision and drainage of bilateral ischiorectal fossa abscesses. During surgery to debride the necrotic tissue the rectum was found to be perforated necessitating laparotomy and subsequent abdomino-perineal resection. Although previous reports of Fournier's gangrene in the hiv positive population exist, rectal involvement requiring excision has not previously been reported. ( info) |
| A 17-year-old boy presented with fournier gangrene associated with previously undiagnosed Crohn ileocolitis. fournier gangrene was managed by debridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with crohn disease. crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal. ( info) |
5/65. Fournier's gangrene caused by candida species as the primary organism. Fournier's gangrene is a rare entity caused by polymicrobial aerobic and anaerobic bacteria. We report a case of Fournier's gangrene caused by candida as the primary organism. A 65-year-old man presented with perineal soft-tissue infections. He underwent surgical debridement and suprapubic cystostomy with both antifungal and antimicrobial therapy. The histopathologic examination revealed necrotizing fasciitis with candida species as the sole initial pathogen. The case suggests that primary fungal pathogens should be considered as a causative organism of Fournier's gangrene. ( info) |
| magnetic resonance imaging and ultrasound are the imaging modalities recommended in the early diagnosis of Fournier's gangrene. Because of the high mortality of this inflammatory disease early diagnosis is essential to initiate adequate surgical and medical treatment. In the clinical literature only a handful of cases, in which diagnosis of Fournier's gangrene is based on MRI findings, have been reported; therefore, we report another case which shows the ability of MRI especially to determine the point of origin and extension of disease. ( info) |
7/65. Fournier's gangrene: report of six cases. Fournier's gangrene (FG) is a fatal infectious disease with necrotic fasciitis of the external genitalia. This disease persists to this day in spite of recent advances in antibiotics. Although fewer than 100 cases have been reported in japan, we have treated six cases in the last 4 years. The patients consisted of five men and one woman, with an average age of 47.5 years. All patients received surgical treatment including incisions, aggressive debridement, drainage, irrigation, and antibiotic therapy. Two patients, who suffered from underlying diseases of diabetic nephropathy and inclusion body myositis, died. These findings confirm the fact that FG requires a prompt diagnosis and immediate surgical treatment. ( info) |
8/65. Necrotizing perineal fasciitis in two paraplegic nursing-home residents: CT imaging findings. Necrotizing fasciitis is a severe infection of the superficial fascia. Early recognition and aggressive management are essential to the treatment of this highly morbid disease. The clinical and physical findings are often the initial clues leading to the correct diagnosis. Computed tomography can play a crucial role in delineating the anatomy, evaluating for the extent of the infection, and for eventual complications. Before the advent of cross-sectional imaging, the majority of suspected patients underwent extensive surgical debridement procedures with resultant morbidity and mortality. We present two cases in which computed tomography played a major role in determining the need for emergent surgery and conservative management. ( info) |
9/65. calciphylaxis of the penis: a unique cause of Fournier's gangrene. calciphylaxis is a rare disease that is caused by calcium deposition in medium and small sized vessels of the skin causing ischemic necrosis. These lesions often become infected and cause septicemia. We report a unique case of penile and scrotal calciphylaxis that rapidly progressed to Fournier's gangrene. We review the etiology of calciphylaxis and also its management. ( info) |
10/65. Prepucial skin flap for reconstruction of the scrotum in Fournier's gangrene. A new procedure for reconstructing a scrotal defect caused by Fournier's gangrene is described. Complete and quick coverage of the exposed testicles is important aesthetically and functionally. A dorsally based prepucial flap is designed, flap viability is ensured by an abundant blood supply and venous drainage. This procedure for reconstruction of ventral hemiscrotum by using a flap of prepucial skin in non-circumcised persons has proved effective in selected cases. ( info) |