Case Report
Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report
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* Corresponding author: Mohammd Kazem Moslemi moslemi_urologist@yahoo.com
1 Department of Urology, Kamkar Hospital, Qom Medical Sciences University, School of Medicine, Bajak Ave, Qom, Iran
2 Department of Urology, Shariati Hospital, Tehran Medical Sciences University, School of Medicine, Kargar Shomali Ave, Tehran, Iran
3 Department of Mechanics, South Methodist University, Dallas, Texas, USA
4 Department of Health, Kamkar Hospital, Qom Medical Sciences University, School of Medicine, Bajak Ave, Qom, Iran
Cases Journal 2009, 2:9136 doi:10.1186/1757-1626-2-9136
Published: 3 December 2009Abstract
Introduction
Fournier gangrene is a rare necrotising fascitis of the perineum and genitals caused by a mixture of aerobic and anaerobic microorganisms. The first case was described by Baurienne in 1764 but the condition was named by Fournier in 1883 who reported the cases of five men with the condition with no apparent etiology. Infection most commonly arises from the skin, urethra, or rectal regions. Despite appropriate therapy, mortality in this disease is still high. We report a case of a low rectal malignancy presenting as Fournier gangrene. This case report serves to highlight an extremely unusual presentation of rectal cancer, a common surgical pathology.
Case presentation
The patient is a 48 years old Afghanian male that admitted with Fournier gangrene. In the course of medical and surgical treatment the presence of extensive rectal adenocarcinoma was discovered. After partial recovery, standard loop colostomy was inserted. Skin grafting of necrotic areas was performed and systemic rectal cancer chemotherapy initiated after full stabilization.
Conclusion
Fournier gangrene is an uncommon but life threatening condition with high associated mortality and morbidity. Usually there is an underlying cause for the development of Fournier gangrene, that if addressed correctly, can lead to a good outcome. Early diagnosis and treatment decrease the morbidity and mortality of this life threatening condition. Good management is based on aggressive debridement, broad spectrum antibiotics and intensive supportive care.