Fournier gangrene: rare complication of rectal cancer

Abstract

Fournier's Gangrene is a rare complication of rectal cancer. Its discovery is often delayed. It's incidence is about 0.3/100 000 populations in Western countries. We report a patient with peritoneal perforation of rectal cancer revealed by scrotal and perineal necrotizing fasciitis.

Fournier’s Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature

“…Local procedures and chronic indwelling catheters increase the risk of infection. Chemotherapy as a treatment for a previously diagnosed unrelated cancer was seen in 15% (3/20) of the case reports [3][4][5][6][7].…”

“…CT has been proven to have greater specificity than plain film radiography or ultrasonography for identifying the process and the extent of the disease and can help to identify a local or distant malignancy [13]. Common CT findings of FG include soft-tissue stranding and edema, asymmetric fascial thickening, coexisting fluid collections, subcutaneous or deep soft tissue emphysema, or findings consistent with a mass lesion, invading the surrounding tissues [5,6]. In our review, CT was performed in 70% (14/20) of the patients; all patients showed at least one finding, and 85% (12/14) demonstrated a mass lesion with inflammation extending into soft tissue [7,12].…”

“…The antibiotic regimen should cover Staphylococcus, Enterococcus, Escherichia coli, and other Gram-negative pathogens and anaerobes (including Bacteroides and Clostridium species). Most commonly used agents include broad-spectrum penicillin with a beta-lactamase inhibitor, a second-or third-generation cephalosporin, a carbapenem, in combination with agents that cover potentially resistant Gram-positive bacteria and anaerobes, i.e., Vancomycin or Daptomycin, Clindamycin, and/or Metronidazole [5,6,14,16]. As soon as culture results are available, a targeted therapy should be implemented.…”

“…Tissue sampling for histologic examination and Gram stain/culture should be obtained in all patients. Wound management initially should consist of frequent wet to dry dressing changes and later may include the use of vacuum-assisted wound management systems [5,6].…”

A rare case of colonic perforation presenting as Fournier’s gangrene

“…5 Although few cases of FG developing through local spread of infection after rectum and sigmoid perforation have been reported in literature, to the best of our knowledge there has been only 1 case of FG developing from intestinal perforation with an inguinal hernia. [6][7][8][9] In this article we describe a case of colonic perforation peritonitis presenting with FG.…”