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Li Y, Piao Z, Ge X, Feng J, Sun D, Zhang J. Environmental pollutants and rectal cancer: The impact of water contamination. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 294:118072. [PMID: 40127547 DOI: 10.1016/j.ecoenv.2025.118072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 03/14/2025] [Accepted: 03/14/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Water is a fundamental resource for life, and exposure to water contamination has far-reaching implications for an increased risk of tumor diseases. METHODS Studies of rectal and colorectal cancer related to water contamination were identified from the published literature in the PUBMED databases from 2010 to 2024. RESULTS This review provides a critical analysis of the current evidence, summarizing the association of water contamination, including industrial waste, pesticides, heavy metals, with rectal and colorectal cancer. It highlights their impact on rectal and colorectal cancer progression by underlying processes of DNA damage, chronic inflammation, and microbial contamination. CONCLUSION Rectal cancer is a significant global health concern with a strong association between environmental pollutants in water sources and increased incidence of rectal cancer. It is vital to identify how waster pollutants influence the development and progression of rectal cancer and formulate targeted preventive approaches and social interventions to decrease the disease's impact.
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Affiliation(s)
- Yezhou Li
- Department of Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Zhe Piao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xinbin Ge
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Jinbao Feng
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Denghua Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China.
| | - Jiayu Zhang
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China.
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Han X, Huang X, Zhang J, Li W, Ma Z, Ma B, Maswikiti EP, Yin Z, Wang Y, Gao L, Chen H. Case report: is necrotizing fasciitis in a rectal cancer patient after targeted systemic therapy related to the tumor site? - evidence from a hepatocellular carcinoma patient. Infect Agent Cancer 2024; 19:45. [PMID: 39304909 DOI: 10.1186/s13027-024-00607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/30/2024] [Indexed: 09/22/2024] Open
Abstract
Necrotizing fasciitis (NF) is a rare and life-threatening serious infectious disease, characterized by acute onset and rapid progress, leading to extensive necrosis of skin, soft tissue as well as fascia by a variety of aerobic and anaerobic bacteria, localized on external genitalia, scrotum, groin and perianal areas in males. There exist numerous common etiologies for NF, yet NF induced by malignant neoplasms is exceedingly rare. Several studies have reported that NF may be associated with tumor site (rectal/sigmoid colon cancer) and blood supply dysfunction caused by targeted therapy drugs (bevacizumab, aflibercept, ramucirumab). The perforation of colorectal cancer poses a unique risk factor for NF. However, in our two cases, the patient with rectal cancer received CapeOX (oxaliplatin + capecitabine) + bevacizumab + tislelizumab for 3 cycles without perforation but did develop NF. One month after debridement, the patient continued immunotherapy with tislelizumab alone for the fourth cycle and maintained for an additional 3 cycles without any recurrence of NF. Therefore, does the occurrence of NF correlate with the tumor site (rectum) and targeted immunotherapy? Another patient with hepatocellular carcinoma also developed NF after receiving 2 cycles of lenvatinib + sintilimab treatment. The third cycle of sintilimab immunotherapy was administered on the 13th day after operation, which was subsequently maintained for an additional 2 cycles without recurrence of NF. The absence of a direct correlation between hepatocellular carcinoma and rectal tumor location as well as immunotherapy, suggests that NF may be closely linked to targeted therapy.
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Affiliation(s)
- Xiaowen Han
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Xiaodong Huang
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Jiayi Zhang
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Weidong Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Zhen Ma
- Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Bin Ma
- Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | | | - Zhenyu Yin
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yuhan Wang
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Lei Gao
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Hao Chen
- Department of Surgical Oncology, Lanzhou University Second Hospital, Lanzhou, 730030, China.
- Key Laboratory of Environmental Oncology of Gansu Province, Lanzhou, China.
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3
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Yu KQ, Li HX, Wu J. Suspected coexistence of perianal necrotizing sweet syndrome in chronic myelomonocytic leukemia: A case report. World J Gastrointest Surg 2024; 16:1176-1183. [PMID: 38690058 PMCID: PMC11056667 DOI: 10.4240/wjgs.v16.i4.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Chronic myelomonocytic leukemia (CMML) complicated with Sweet syndrome (SS) is a rare hematological neoplasm. However, cases of concomitant development of perianal necrotizing SS (NSS) have not been reported. CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess. He developed postoperative incision infection and was referred to the department where the authors work. Initially, perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected. Despite receiving antibiotic therapy and undergoing surgical debridement, deeper necrotic areas formed in the patient's perianal wounds, accompanied by persistent high fever. Blood and fungal cultures yielded negative results. The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS. CONCLUSION CMML with perianal NSS is a rare condition, often misdiagnosed as perianal abscess or perianal necrotizing fasciitis. Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
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Affiliation(s)
- Ke-Qiang Yu
- Clinical Medicine School, Chengdu University of Chinese Medicine, Chengdu 610072, Sichuan Province, China
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui-Xiang Li
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Wu
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Hou S, Cheng B, Shen K, Gao Z, Liu F, Ye Y. Fournier's gangrene due to rectal cancer: A case report. Mol Clin Oncol 2024; 20:30. [PMID: 38476336 PMCID: PMC10928661 DOI: 10.3892/mco.2024.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/04/2024] [Indexed: 03/14/2024] Open
Abstract
Fournier's gangrene (FG) is an extremely rare necrotizing fasciitis that is insidious, rapidly spreading and life-threatening. FGs due to rectal cancer occur rarely and there is a lack of clinical reference. In the present study, a severe FG due to rectal cancer perforation was described and the features of this rare disease were summarized with a literature review. A 57-year-old man was admitted because of rectal cancer-induced FG. The patient was misdiagnosed with extensive perianal abscess until the intraoperative biopsy confirmed that rectal cancer was the culprit. Incision, debridement and drainage were carried out to reduce infectious burdens. After that, the patient was transferred to Peking University People's Hospital for the subsequent therapy. Empirical broad-spectrum antibiotic therapy was used at the initial stage. Diversional transverse loop colostomy was performed to control infection and resume oral feeding. After four rounds of vacuum-assisted closure (VAC) therapy, radical resection and wound closure were accomplished. The scrotal defect was repaired by a skin flap. Pathological results indicated a moderately differentiated adenocarcinoma with perforation. The patient was discharged from the hospital on postoperative day 15 without any post-operative complications. No signs of recurrence were observed during a 22-month follow-up. In the setting of rectal cancer-induced FGs, the liquid resuscitation, broad-spectrum antibiotic therapy, and prompt debridement are the cornerstones of the initial management. Diversional colostomy and VAC therapy were effective in the management of severe infection and large wounds. The present case report also provided a clinical reference for the implementation of staged surgeries and the perioperative multidisciplinary management of FGs.
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Affiliation(s)
- Sen Hou
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Baosen Cheng
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Kai Shen
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Zhidong Gao
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Fan Liu
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing 100044, P.R. China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, P.R. China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing 100044, P.R. China
- Laboratory of Surgical Oncology, Peking University People's Hospital, Beijing 100044, P.R. China
- Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing 100044, P.R. China
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Rieger C, Pfister D, Heidenreich A. [Emergencies in cancer therapy: surgical indications under systemic therapy]. Aktuelle Urol 2024; 55:60-64. [PMID: 37607584 DOI: 10.1055/a-2129-7104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Emergency surgery due to side-effects of cancer therapy in patients with metastatic disease of the genitourinary tract is rare. Nevertheless, there are a number of emergencies that require rapid intervention and should be recognized by every uro-oncologist. The following review will work out important side-effects requiring surgical treatment, highlighting the main symptoms and the initial management.
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Affiliation(s)
- Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Koln, Germany
| | - David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Koln, Germany
| | - Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Koln, Germany
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Jung HC, Kim YU. Fournier's gangrene after insertion of thermo-expandable prostatic stent for benign prostatic hyperplasia: A case report. World J Clin Cases 2023; 11:6498-6504. [PMID: 37900218 PMCID: PMC10601010 DOI: 10.12998/wjcc.v11.i27.6498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/15/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Thermo-expandable urethral stent (Memokath 028) implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction. Following prostatic urethral stent implantation, minor complications such as urinary tract infection, irritative symptoms, gross hematuria, and urethral pain have been observed; however, there are no reports of life-threatening events. Herein, we report a critical case of Fournier's gangrene that occurred 7 years after prostatic stenting. CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia (volume, 126 ccs; as measured by transrectal ultrasound) had undergone insertion of a thermo-expandable urethral stent (Memokath 028) as he was unfit for surgery under general anesthesia. However, the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent (Memokath 028). We had planned to remove the Memokath 028; however, the patient was lost to follow-up. The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area. In digital rectal examination, tenderness and heat of prostate was identified. Also, the black skin color change with foul-smelling from right scrotum to right inguinal area was identified. In computed tomography finding, subcutaneous emphysema was identified to same area. He was diagnosed with Fournier's gangrene based on the physical examination and computed tomography findings. In emergency room, Fournier's gangrene severity index value is seven points. Therefore, he underwent emergent extended surgical debridement and removal of the Memokath 028. Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed. However, the patient died 14 days after surgery due to multiorgan failure. CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients, its rapid removal may help prevent severe complications.
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Affiliation(s)
- Hee Chang Jung
- Department of Urology, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Yeong Uk Kim
- Department of Urology, Yeungnam University College of Medicine, Daegu 42415, South Korea
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Yano T, Nakano K, Yoshimitsu M, Idani H, Okajima M. Successful resection of rectal cancer and perirectal abscess following systemic chemotherapy and chemoradiotherapy: A case report. Int J Surg Case Rep 2023; 108:108403. [PMID: 37329610 PMCID: PMC10382744 DOI: 10.1016/j.ijscr.2023.108403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Perirectal abscesses are uncommon in colorectal cancer. Although abscess infection should be controlled before colorectal cancer treatment, abscess formation makes surgical resection and preoperative treatment difficult. There is currently no established treatment for colorectal cancer with perirectal abscesses. Here, we present a case of rectal cancer with a perirectal abscess that was resected after systemic chemotherapy followed by chemoradiotherapy. CASE PRESENTATION A 73-year-old man presented to the outpatient clinic with complaints of weight loss and general malaise. Colonoscopy revealed a circumferential tumor 3 cm from the anal verge, and examination of the endoscopic biopsy specimen indicated a well-differentiated tubular adenocarcinoma. Pelvic magnetic resonance imaging revealed a perirectal abscess on the ventral aspect of the rectum. After sigmoid colostomy was performed to control the infection, 4 cycles of panitumumab and modified fluorouracil, leucovorin, and oxaliplatin were administered. After the perirectal abscess disappeared, chemoradiotherapy to the whole pelvis (radiotherapy 45Gy/25 fractions plus tegafur-gimeracil-oteracil) was administered. Total pelvic exenteration with an ileal conduit was performed via open surgery. The pathological diagnosis was well-differentiated tubular adenocarcinoma with complete resection and negative resection margins. No recurrence of cancer has been observed 26 months after surgery. CLINICAL DISCUSSION Treatment of colorectal cancer with perirectal abscess is difficult to define the extent of resection due to the spread of inflammation. We believe that treatment should address high risk of local recurrence. CONCLUSION After sigmoid colostomy, complete resection of colorectal cancer with perirectal abscess could be achieved by systemic chemotherapy followed by chemoradiotherapy.
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Affiliation(s)
- Takuya Yano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan.
| | - Kanyu Nakano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan
| | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-ku, Hiroshima 730-8518, Japan; Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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8
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Yoshikawa Y, Suzuki K, Hashimoto T, Omagari K, Sasaki T, Tomita Y, Tamura A. Clinical complete response maintained for more than 5 years after aggressive chemoradiotherapy for advanced rectal cancer with necrotizing fasciitis: a case report. J Surg Case Rep 2023; 2023:rjad292. [PMID: 37332663 PMCID: PMC10271215 DOI: 10.1093/jscr/rjad292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/01/2023] [Indexed: 06/20/2023] Open
Abstract
We report the case of a 65-year-old male diagnosed with advanced rectal cancer associated with necrotizing fasciitis (NF). Since radical surgery, total pelvic exenteration with sacrectomy, was rejected because of detrimental effects on quality of life, chemoradiotherapy (CRT) was chosen as anti-cancer treatment after urgent debridement. Although CRT was paused unintentionally just after delivering the total dose of radiation owing to the relapse of NF, the patient has maintained clinical complete response (cCR) without any distant metastasis for >5 years. Advanced rectal cancer is recognized as an NF risk factor. No definitive treatment strategies have been reported for NF-inducing rectal cancer; however, some reports have demonstrated curative extended surgery. Thus, CRT may be a less-invasive treatment option for NF-inducing rectal cancer, whereas severe adverse effects including re-infection after debridement should be closely monitored.
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Affiliation(s)
- Yusuke Yoshikawa
- Corresponding address. Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi 3208580, Japan. Tel: 028-622-5241; Fax: 028-625-2718;
| | - Keiichi Suzuki
- Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi, Japan
| | - Takeo Hashimoto
- Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi, Japan
| | - Kenshi Omagari
- Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi, Japan
| | - Taketo Sasaki
- Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi, Japan
| | - Yusuke Tomita
- Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi, Japan
| | - Akihiko Tamura
- Department of Surgery, National Hospital Organization Tochigi Medical Center, 1-10-37 Nakatomatsuri, Utsunomiya-Shi, Tochigi, Japan
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SIRAGUSA L, SFORZA D, SENSI B, PATHIRANNEHALAGE DON C, DE LUCA L, CIANCIO MANUELLI M, TOMEI B, VATTERMOLI L, VILLA M, GRANDE M. Left thigh necrotizing fasciitis secondary to colocutaneous fistula in previously treated rectal cancer: case report of a single, late and fatal complication. Chirurgia (Bucur) 2023. [DOI: 10.23736/s0394-9508.22.05422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
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Mahmood BA, ElSayed EH, Ali SA. Effect of Colostomy on Treatment Outcome in Fournier Gangrene: A Prospective Comparative Study. Plast Surg (Oakv) 2023; 31:24-28. [PMID: 36755819 PMCID: PMC9900038 DOI: 10.1177/22925503211024757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients' groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn't statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.
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Affiliation(s)
- Barakat A. Mahmood
- Plastic and Reconstructive Surgery Department, Faculty of Medicine,
Helwan University, Cairo, Egypt
| | - Emad H. ElSayed
- Plastic and Reconstructive Surgery Department, Faculty of Medicine
(Girls), Al-Azhar University, Cairo, Egypt
| | - Sherif A. Ali
- General Surgery Department, Faculty of Medicine, Helwan University,
Cairo, Egypt
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11
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Chen GH, Wang Y, Zhang RJ, Leng DL, Li L. Rectal malignant tumor complicated with perianal necrotizing fasciitis: A case report. Shijie Huaren Xiaohua Zazhi 2022; 30:1095-1100. [DOI: 10.11569/wcjd.v30.i24.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Perianal necrotizing fasciitis (PNF) has been reported to be caused by multiple factors, but rectal malignant tumors, as an extremely rare predisposing factor, are often easily overlooked by surgeons.
CASE SUMMARY An elderly male patient was admitted due to "right perianal swelling and pain with fever for 3 d" and was diagnosed with PNF, rectal mass, and perianal abscess. The mass was diagnosed as rectal adenocarcinoma after debridement. According to the patient's condition, re-debridement intervention and antibiotic adjustment were given, followed by colostomy and radical resection of the adenocarcinoma. The patient recovered well after 3 mo of follow-up.
CONCLUSION The present case suggests that high attention should be paid to etiological factors of PNF in clinical practice to avoid delayed treatment due to missed diagnosis and misdiagnosis. For patients with rectal malignant tumors and PNF, early diagnosis is very important, and it is still recommended to give priority to the treatment of PNF in the acute phase after diagnosis, followed by comprehensive treatment of rectal malignant tumors, which is of great significance for the prognosis of patients.
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Affiliation(s)
- Guang-Hua Chen
- Department of Anorectal Surgery, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China
| | - Yan Wang
- Jiangxi University of Traditional Chinese Medicine School of Clinical Medicine, Nanchang 330006, Jiangxi Province, China
| | - Ru-Jie Zhang
- Jiangxi University of Traditional Chinese Medicine School of Clinical Medicine, Nanchang 330006, Jiangxi Province, China
| | - Dong-Ling Leng
- Jiangxi University of Traditional Chinese Medicine School of Clinical Medicine, Nanchang 330006, Jiangxi Province, China
| | - Lu Li
- Department of Anorectal Surgery, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China
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12
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Michael P, Peiris B, Ralph D, Johnson M, Lee WG. Genital Reconstruction following Fournier's Gangrene. Sex Med Rev 2022; 10:800-812. [PMID: 37051973 DOI: 10.1016/j.sxmr.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and women, often requiring reconstruction. OBJECTIVES The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene. METHODS A literature search was performed on PubMed with the search terms "Fournier"s gangrene" "genital reconstruction" and "Fournier's gangrene phalloplasty." The European Association of Urology's guidelines on Urological infections were also consulted for recommendations. RESULTS Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded. CONCLUSION Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function. Michael P, Peiris B, Ralph D, et al. Genital Reconstruction following Fournier's Gangrene. Sex Med Rev 2022;XX:XXX-XXX.
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Affiliation(s)
- Panos Michael
- UCL Medical School, University College London, London, UK
| | - Bryony Peiris
- UCL Medical School, University College London, London, UK
| | - David Ralph
- St. Peter's Andrology Centre and UCLH, London, UK
| | - Mark Johnson
- St. Peter's Andrology Centre and UCLH, London, UK
| | - Wai Gin Lee
- St. Peter's Andrology Centre and UCLH, London, UK.
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13
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Boaz E, Freund MR, Harbi A, Dagan A, Gilshtein H, Reissman P, Yellinek S. Anorectal Malignancies Presenting as a Perianal Abscess or Fistula. Am Surg 2022:31348221101481. [PMID: 35621130 DOI: 10.1177/00031348221101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. The purpose of this study was to describe patients presenting with acute perianal abscess or fistula who were subsequently diagnosed with anorectal cancer. METHODS We performed a retrospective, review of all cases presenting with acute perianal abscess or fistula who were subsequently found to have anorectal carcinoma on biopsy in two tertiary centers. We analyzed the data focusing on the clinical features, laboratory values, clinical staging of the tumors, the subsequent management, the pathological staging, and the outcome of each patient. RESULTS Overall, 3219 patients presenting with anorectal abscess or fistula were reviewed. Cancer was diagnosed in 16 (.5%) patients, 12 with adenocarcinoma of the rectum and 4 with squamous cell carcinoma of the anus. In 5 patients (31.2%), cancer was diagnosed in the setting of chronic perianal fistula, 4 of them had Crohn's disease. In 10 patients (62.5%), cancer was not diagnosed during the initial evaluation of the acute symptoms. CONCLUSIONS A high index of suspicion is required to make the diagnosis of perianal tumors when assessing patients presenting with perianal sepsis, particularly those with Crohn's disease, a long history of persistent perianal disease, and an advanced age. In most cases, proper drainage followed by proximal diversion are the surgical treatment of choice in the acute setting.
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Affiliation(s)
- Elad Boaz
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Michael R Freund
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Asaf Harbi
- Colorectal Unit, Department of General Surgery, 574334Rambam Health Care Campus, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Dagan
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Hayim Gilshtein
- Colorectal Unit, Department of General Surgery, 574334Rambam Health Care Campus, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Petachia Reissman
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Shlomo Yellinek
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
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14
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Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, Ansaloni L, Adesunkanmi AK, Augustin G, Bala M, Baraket O, Biffl WL, Ceresoli M, Cerutti E, Chiara O, Cicuttin E, Chiarugi M, Coimbra R, Corsi D, Cortese F, Cui Y, Damaskos D, de’Angelis N, Delibegovic S, Demetrashvili Z, De Simone B, de Jonge SW, Di Bella S, Di Saverio S, Duane TM, Fugazzola P, Galante JM, Ghnnam W, Gkiokas G, Gomes CA, Griffiths EA, Hardcastle TC, Hecker A, Herzog T, Karamarkovic A, Khokha V, Kim PK, Kim JI, Kirkpatrick AW, Kong V, Koshy RM, Inaba K, Isik A, Ivatury R, Labricciosa FM, Lee YY, Leppäniemi A, Litvin A, Luppi D, Maier RV, Marinis A, Marwah S, Mesina C, Moore EE, Moore FA, Negoi I, Olaoye I, Ordoñez CA, Ouadii M, Peitzman AB, Perrone G, Pintar T, Pipitone G, Podda M, Raşa K, Ribeiro J, Rodrigues G, Rubio-Perez I, Sall I, Sato N, Sawyer RG, Shelat VG, Sugrue M, Tarasconi A, Tolonen M, Viaggi B, Celotti A, Casella C, Pagani L, Dhingra S, Baiocchi GL, Catena F. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg 2022; 17:3. [PMID: 35033131 PMCID: PMC8761341 DOI: 10.1186/s13017-022-00406-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 02/08/2023] Open
Abstract
Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections.Together, the World Society of Emergency Surgery, the Global Alliance for Infections in Surgery, the Surgical Infection Society-Europe, The World Surgical Infection Society, and the American Association for the Surgery of Trauma have jointly completed an international multi-society document to promote global standards of care in SSTIs guiding clinicians by describing reasonable approaches to the management of SSTIs.An extensive non-systematic review was conducted using the PubMed and MEDLINE databases, limited to the English language. The resulting evidence was shared by an international task force with different clinical backgrounds.
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Affiliation(s)
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ervis Agastra
- General Surgery Department, Regional Hospital of Durres, Durres, Albania
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ashraf El Sayed Abbas
- Department of General and Emergency Surgery Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Abdulrashid Kayode Adesunkanmi
- Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State Nigeria
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oussama Baraket
- Department of General Surgery Bizerte Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Walter L. Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA USA
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan-Bicocca, Milan, Italy
| | - Elisabetta Cerutti
- Anesthesia and Transplant Surgical Intensive Care Unit, Ospedali Riuniti, Ancona, Italy
| | - Osvaldo Chiara
- Department of Pathophysiology, ASST Niguarda Ca’Granda Hospital, University of Milano, Milan, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System, CECORC Research Center, Loma Linda University, Loma Linda, USA
| | - Daniela Corsi
- General Direction, Area Vasta 3, ASUR Marche, Macerata, Italy
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | - Nicola de’Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Italy
- Université Paris Est, UPEC, Creteil, France
| | - Samir Delibegovic
- Department of Surgery, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zaza Demetrashvili
- Department General Surgery, Kipshidze Central University Hospital, Tbilisi, Georgia
| | - Belinda De Simone
- Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France
| | - Stijn W. de Jonge
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Salomone Di Saverio
- Department of General Surgery, “Madonna del Soccorso” San Benedetto del Tronto Hospital, San Benedetto del Tronto, Italy
| | | | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Joseph M. Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA USA
| | - Wagih Ghnnam
- Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlos Augusto Gomes
- Department of Surgery, Hospital Universitário Terezinha de Jesus, Faculdade de Ciências Médicas E da Saúde de Juiz de Fora, Juiz de Fora, Brazil
| | - Ewen A. Griffiths
- Department of Upper GI Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Timothy C. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital Giessen, Giessen, Germany
| | - Torsten Herzog
- Department of Surgery, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Aleksandar Karamarkovic
- Surgical Clinic “Nikola Spasic”, Faculty of Medicine University of Belgrade, Belgrade, Serbia
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Peter K. Kim
- Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Andrew W. Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Victor Kong
- Department of Surgery, Edendale Hospital, Pietermaritzburg, South Africa
| | - Renol M. Koshy
- Department of General Surgery, University Hospital of Coventry and Warwickshire, Coventry, UK
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, CA USA
| | - Arda Isik
- Department of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Rao Ivatury
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | | | - Yeong Yeh Lee
- School of Medical Sciences, Universitiy Sains Malaysia, Kota Bharu, Kelantan Malaysia
| | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russia
| | - Davide Luppi
- Department of General and Emergency Surgery, ASMN, Reggio Emilia, Italy
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA USA
| | | | - Sanjay Marwah
- Department of Surgery, Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Cristian Mesina
- Second Surgical Clinic, Emergency Hospital of Craiova, Craiova, Romania
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, USA
| | - Frederick A. Moore
- Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, FL USA
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Iyiade Olaoye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Carlos A. Ordoñez
- Division of Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
- Department of Surgery, Universidad del Valle, Cali, Colombia
| | - Mouaqit Ouadii
- Department of Surgery, Hassan II University Hospital, Medical School of Fez, Sidi Mohamed Benabdellah University, Fez, Morocco
| | - Andrew B. Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gennaro Perrone
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Tadeja Pintar
- Department of Surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Giuseppe Pipitone
- Department of Internal Medicine, Division of Infectious Disease, ARNAS Civico-Di Cristina Hospital, Palermo, Italy
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Kemal Raşa
- Department of Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | | | - Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Ines Rubio-Perez
- General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Norio Sato
- Department of Aeromedical Services for Emergency and Trauma Care, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Robert G. Sawyer
- Department of Surgery, Western Michigan University School of Medicine, Kalamazoo, MI USA
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Matti Tolonen
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Bruno Viaggi
- Department of Anesthesiology, Neuro Intensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | | | - Claudio Casella
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Leonardo Pagani
- Department of Infectious Diseases, Bolzano Hospital, Bolzano, Italy
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar India
| | - Gian Luca Baiocchi
- Department of Surgery, AAST Cremona, Cremona, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fausto Catena
- Department of Surgery, “Bufalini” Hospital, Cesena, Italy
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15
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Costa Almeida CE, Azevedo J, Botelho I, Vilaça J. Buschke-Löwenstein tumour: a rare and challenging entity. BMJ Case Rep 2021; 14:e244192. [PMID: 34531235 PMCID: PMC8449944 DOI: 10.1136/bcr-2021-244192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/04/2022] Open
Abstract
Buschke-Löwenstein tumour (BLT) is rare and locally aggressive, and malignant transformation is a possibility. Because there is no consensus on the best treatment approach, the authors present a treatment algorithm based on several case reports. A 57-year-old male patient resorted to surgical consultation with a giant perianal cauliflower-like mass. A BLT was diagnosed. Due to the involvement of the anal sphincter, a wide local excision saving the rectum failed. Abdominoperineal resection was performed. Malignant transformation was diagnosed, and adjuvant radiotherapy was delivered. Clinical evolution was uneventful. Aggressive behaviour despite the absence of malignancy is the hallmark of BLT. The common presentation is an anal mass with a cauliflower-like appearance. Anal verrucous carcinoma and squamous cell carcinoma are the major differential diagnoses. BLT treatment is challenging. Surgery is the first-line treatment, raging from wide local excision to abdominoperineal resection. To improve outcomes, chemoradiation can be used in combination with surgery. Long-term follow-up is mandatory.
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Affiliation(s)
| | - José Azevedo
- General Surgery, Hospital da Horta EPER, Horta, Portugal
| | - Inês Botelho
- General Surgery Consultation Nurse, Hospital da Luz, Vila Nova de Gaia, Portugal
| | - Jaime Vilaça
- General Surgery, Hospital da Luz, Vila Nova de Gaia, Portugal
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16
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Villanueva H, Lam A, Aukerman W, Lowenfeld A, Meade P. Rectal Adenocarcinoma Presenting as Fournier's Gangrene. Am Surg 2020:3134820983200. [PMID: 33356442 DOI: 10.1177/0003134820983200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hugo Villanueva
- Department of Surgery, 22465Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Anthony Lam
- Department of Surgery, 22465Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - William Aukerman
- Department of Surgery, 22465Conemaugh Memorial Medical Center, Johnstown, PA, USA
| | - Adrian Lowenfeld
- 6556Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Paul Meade
- Department of Surgery, 22465Conemaugh Memorial Medical Center, Johnstown, PA, USA
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17
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Olivieri V, Ruggiero G, Abate D, Serra N, Fortunati V, Griffa D, Forte F, Corongiu E. Fatal infections in andrology. Atypical clinical presentation of a Fournier's disease. Arch Ital Urol Androl 2020; 92. [PMID: 33016049 DOI: 10.4081/aiua.2020.3.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient's death. CASE REPORT A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene's foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.
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Affiliation(s)
- Valerio Olivieri
- Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin).
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18
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Mann AJ, Reinoso DB, Genuit T, Jimenez J. Fournier's Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature. Cureus 2020; 12:e10317. [PMID: 33052278 PMCID: PMC7544611 DOI: 10.7759/cureus.10317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Most case series of Fournier's gangrene (FG) do not list malignancy as a cause; however, isolated cases with underlying malignancy of the soft tissue, genitourinary, and gastrointestinal systems have been described. After a review of recently published literature, 20 case reports and 15 case series or review articles included relevant information and were included in this literature review. Malignancy is overlooked in 10% (2/20) of patients, resulting in a delayed diagnosis and initiation of cancer treatment. All patients with FG should have a thorough cancer history, digital rectal examination, appropriate local and systemic imaging, as well as tissue biopsies, to reduce the likelihood of a missed cancer diagnosis. Delay in management of the local malignancy may lead to persistence or recurrence of the infection and significantly worsens overall outcome and survival.
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Affiliation(s)
- Adam J Mann
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | - Thomas Genuit
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Jesus Jimenez
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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19
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Fournier's gangrene in a rectal cancer patient. Int J Surg Case Rep 2020; 67:150-153. [PMID: 32062122 PMCID: PMC7021527 DOI: 10.1016/j.ijscr.2020.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/14/2020] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Rectal cancer induced Fournier's gangrene is mainly caused by cancer perforation. Vacuum assisted closure treatment helps to accelerate the healing of surgical wound. Prompt diagnosis and urgent surgery are crucial for patient’s favorable outcome. Introduction Fournier’s gangrene (FG) is caused by a variety of causes, but FG led by rectal cancer is rare. Presentation of case A 62-year-old man presented with perineal pain for several days. Multiple black spots on the scrotum and perineum surrounded by erythema were found on a physical exam. Computed tomography showed diffuse air density with subcutaneous edema in the perineum, scrotum, anus, and left lower abdominal wall and showed 4.1 cm-size mass in anus. He was diagnosed with FG caused by rectal cancer. He underwent extensive debridement of the perineum, scrotum, medial buttocks, and diverting loop colostomy of transverse colon. After repeated debridement of some residual necrotic tissue, abdominal perineal resection was performed after 24 days after initial surgery. The patient received reconstruction surgery of the soft tissue defect and discharged on postoperative day 84. He is being followed up without any recurrence for 10 months. Conclusion Prompt clinical diagnosis and urgent surgical management are crucial for patient’s favorable outcome. The patient in our case study could be recovered by a combined modality therapy we provided.
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20
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Řezáč T, Stašek M, Zbořil P, Vomáčková K, Bébarová L, Hanuliak J, Neoral Č. Necrotizing pelvic infection after rectal resection. A rare indication of endoscopic vacuum-assisted closure therapy. A case report. Int J Surg Case Rep 2019; 61:44-47. [PMID: 31315075 PMCID: PMC6630029 DOI: 10.1016/j.ijscr.2019.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Anastomotic leak after colorectal surgery is a major problem associated with higher morbidity and mortality. In most cases of contained leaks, treatment recommendations are clear and effective. However, in rare cases like necrotizing pelvic infection, there is no clear treatment of choice, despite the mortality rate almost 21%. We present successful management with endoscopic vacuum-assisted closure therapy. THE PRESENTATION OF A CASE A 68-year-old female patient with BMI 26, hypothyroidism and high blood pressure was indicated to low anterior rectal resection because of high-risk neoplasia of lateral spreading tumor type of the upper rectum. Four days after the primary operation, sepsis (SOFA 12) with diffuse peritonitis and unconfirmed leak according to CT led to surgical revision with loop ileostomy. On postoperative days 6-10, swelling, inflammation and subsequent necrosis of the right groin and femoral region communicating with the leak cavity developed. The endoscopy confirmed a leak of 30% of the anastomotic circumference with the indication of debridement and endoscopic vacuum-assisted closure therapy. EVAC sessions with 3-4 day intervals healed the leak cavity. Secondary healing of the skin defects required 4 months. CONCLUSION Necrotizing pelvic infection after a leak of the colorectal anastomosis is a very rare complication with high morbidity and mortality. Endoscopic vacuum-assisted closure therapy should be implemented in the multimodal therapeutic strategy in case of major leaks, affecting up to 270° of the anastomotic circumference.
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Affiliation(s)
- Tomáš Řezáč
- Department of Surgery I, University Hospital Olomouc, Olomouc 77900, Czech Republic.
| | - Martin Stašek
- Department of Surgery I, University Hospital Olomouc, Olomouc 77900, Czech Republic.
| | - Pavel Zbořil
- Department of Surgery I, University Hospital Olomouc, Olomouc 77900, Czech Republic.
| | - Katherine Vomáčková
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc 77900, Czech Republic.
| | - Linda Bébarová
- Department of Surgery I, University Hospital Olomouc, Olomouc 77900, Czech Republic.
| | - Jan Hanuliak
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc 77900, Czech Republic.
| | - Čestmír Neoral
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc 77900, Czech Republic.
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Bocchiotti MA, Bogetti P, Parisi A, Rivarossa F, Frenello A, Baglioni EA. Management of Fournier's gangrene non-healing wounds by autologous skin micrograft biotechnology: a new technique. J Wound Care 2019; 26:314-317. [PMID: 28598758 DOI: 10.12968/jowc.2017.26.6.314] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fournier's gangrene is an acute bacterial infection producing necrosis of the perineum and external genitalia that generally affects elderly men. Although skin grafts and flaps are the standard procedure for reconstruction, sometimes wounds can become chronic. Rigenera Protocol is a new technique based on autologous skin micrografts that reactivates and supports wound healing. A 40-year-old male with Fournier's gangrene, due to a rectal microperforation following diarrhoea, was treated with surgical debridement, negative pressure wound therapy and subsequently coverage with skin grafts. He developed non-healing wounds treated by Rigenera protocol after two months of advanced wound dressings. This technique is based on skin micrografts obtained by mechanical dermal disgregation to provide mesenchymal stem cells and extracellular matrix to the wound. The suspension injected into the wound triggers reactivation of healing without significant residual scarring on both donor site and treated area. Non-healing wounds were reduced by 15% at day 7 and by 50% after 30 days. Wounds completely healed after seventy days. The regenerated tissue appeared closer to skin graft than to scar tissue. This report shows how the use of skin micrografts through Rigenera protocol can be a useful method to reactivate wound healing resulting from Fournier's gangrene, with no discomfort for patient in a practical, safe and easy way.
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Affiliation(s)
- M A Bocchiotti
- Plastic Surgeon, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - P Bogetti
- Professor, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - A Parisi
- Resident, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - F Rivarossa
- Resident, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - A Frenello
- Resident, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
| | - E A Baglioni
- Plastic Surgeon, Department of Reconstructive and Plastic Surgery, Città della Salute e della Scienza Hospital, University of Turin, Italy
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Koyama R, Maeda Y, Minagawa N, Shinohara T, Hamada T. Laparoscopic Resection of an Abdominal Wall Metastasis 5 Years after Primary Colorectal Cancer Resection. Case Rep Gastroenterol 2019; 13:78-84. [PMID: 31043933 PMCID: PMC6477500 DOI: 10.1159/000497098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 12/26/2022] Open
Abstract
We report the case of a 65-year-old male with a metachronous abdominal wall metastasis secondary to colorectal cancer. The patient had presented 5 years ago to another facility with a perforated sigmoid colon cancer (pT4a[SE], N0, M0, pStage II), rectal cancer (T2[MP], N0, M0, pStage I), and Fournier gangrene. He had then undergone sigmoidectomy and rectal resection along with S-1 adjuvant chemotherapy. No relapse was observed thereafter. However, currently, 5 years after initial surgery, the patient noticed a palpable mass in the left lower abdomen and was referred to our hospital for further assessment and treatment. Percutaneous echo-guided needle biopsy of the tumor revealed an adenocarcinoma tissue. Following 6 courses of FOLFOX plus cetuximab chemotherapy, laparoscopic resection for abdominal wall metastasis was successfully performed. The resected tissue was pathologically characterized as adenocarcinoma, which was compatible with the recurrence of the primary colorectal carcinoma resected 5 years ago. The abdominal wall metastasis was attributed to the cancer cell implantation secondary to the perforated sigmoid colon cancer treated 5 years ago.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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A fatal case of Fournier's gangrene during neoadjuvant radiotherapy for rectal cancer. Strahlenther Onkol 2018; 195:441-446. [PMID: 30470845 DOI: 10.1007/s00066-018-1401-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To report the development of an ultimately fatal occurrence of Fournier's gangrene in a rectal cancer patient undergoing neoadjuvant radiotherapy without chemotherapy. METHODS A 53-year-old male patient with G2 cT3 cN1a cM0 stage IIIB adenocarcinoma of the lower rectum and several comorbidities including ulcerative colitis was treated with 56 Gy to the primary tumor in 28 fractions because he declined the recommended simultaneous chemotherapy. He was also enrolled in the ketogenic diet arm of our KETOCOMP study, so that prospective measurements of blood parameters, quality of life, and body composition were made. RESULTS The patient died 6 days after completion of radiotherapy due to septic shock associated with Fournier's gangrene reaching from the right buttock into the gluteal muscles and descending into the scrotum. In retrospect, there were several signs probably indicating the development of the gangrene: (i) a decline in bioelectrical phase angle; (ii) an accelerated weight and fat-free mass loss starting in the third week of radiotherapy; (iii) an increase in C-reactive protein (CRP) and concurrent drop in high-density lipoprotein (HDL) cholesterol and insulin-like growth factor(IGF)-1 concentrations; and (iv) the occurrence of a sharp pain in the perianal region reported in the fifth week of radiotherapy. Notably, his self-reported quality of life score was the same at the end of as before radiotherapy. CONCLUSIONS This case highlights the occurrence of Fournier's gangrene as an extremely rare but life-threatening complication during neoadjuvant radiotherapy for rectal cancer which should be refreshed in the awareness of radiation oncologists and radiologists.
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24
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Sockkalingam VS, Subburayan E, Velu E, Rajashekar ST, Swamy AM. Fournier's gangrene: prospective study of 34 patients in South Indian population and treatment strategies. Pan Afr Med J 2018; 31:PAMJ-31-110. [PMID: 31037161 PMCID: PMC6462357 DOI: 10.11604/pamj.2018.31.110.15495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineum and genitalia. The objective of this study was to study the etiology and microbiology associated with FG and to study the debridement and reconstructive procedures required in these patients. Methods This was a prospective follow up study conducted from September 2011 to November 2012 at Coimbatore medical college hospital, Coimbatore, India. Patients presenting to the outpatient department and emergency department with the clinical diagnosis of FG were included in the study. Results A total of 34 patients were studied in the study period. The mean age of presentation in years was 50±11.13. The male to female ratio was 33:1. The source of the infection was most commonly anorectal. Diabetes mellitus was the most common co morbid factor associated. Most commonly the disease was polymicrobial with escherichia coli being the commonest grown organism. The average number of wound debridement required was 2.9±1.42. Primary closure of the scrotal skin defect was the most common reconstructive procedure performed. Mortality associated with the disease in our series was 11.8%. Conclusion Although FG is a relatively rare disease, it is still prevalent in Indian population. Incidence of FG in HIV patients is high, even though it is not the commonest of the co morbid condition. The mortality can be kept to minimal with aggressive medical and surgical management. Extensive raw area following the infection and wound debridement can be managed by simple reconstructive procedures with good outcome.
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Affiliation(s)
| | | | - Elango Velu
- Department of Surgery, Coimbatore Medical College, Coimbatore, India
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25
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Abstract
We present the case of an eighty-two-year-old man who presented with testicular pain, diarrhoea, fresh rectal bleeding, and weight loss. A clear history was not obtained because of presumed chronic confusion secondary to age related vascular dementia. He was subsequently diagnosed with Fournier’s gangrene and a retrospective obtainment of his collateral history revealed a completely normal pre-morbid cognitive level of function. Thus, his confusion was secondary to an atypical cause of sepsis and he was managed with surgical debridement. We highlight the value of urgent computed tomography (CT) scanning as well as the use of screening tools for assessing cognitive function, particularly in surgical specialties, as well as the importance of obtaining a collateral history and discussing means for better collaborative efforts amongst surgeons and physicians in managing the “confused patient”.
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26
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Pittaka M, Georgiou C, Polyviou P, Kountourakis P, Loizou P, Constantinou I, Andreopoulos D, Vassiliou VP. Fournier Gangrene in a patient receiving chemo-radiation for rectal cancer. Oxf Med Case Reports 2018; 2018:omx101. [PMID: 29507738 PMCID: PMC5827339 DOI: 10.1093/omcr/omx101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/19/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023] Open
Abstract
We herein present a case of a 24-year-old patient with a cT4N+ rectal cancer who developed Fournier's gangrene (FG) 1 week after the completion of preoperative chemoradiotherapy. The patient was promptly referred to the surgical department where she was treated with antibiotics and repeated surgical debridement. FG is a rare and life-threatening situation that needs to be managed aggressively with no delay. The clinical image above is unique and characteristic of this clinical entity.
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Affiliation(s)
- Maria Pittaka
- Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | | | - Petros Polyviou
- Diagnostic Radiology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | | | - Panayiotis Loizou
- Department of General Surgery, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | - Vassilios P Vassiliou
- Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus
- Correspondence address. Department of Radiation Oncology, Bank of Cyprus Oncology Center 2006, 32 Acropoleos Avenue, Strovolos 2012, Nicosia, Cyprus. Tel: +357-22-847407; Fax: +357-22-841483;
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27
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Gastric Schwannoma—a rare benign mimic of gastrointestinal stromal tumour. Oxf Med Case Reports 2018; 2018:omx102. [PMID: 29564142 PMCID: PMC5844217 DOI: 10.1093/omcr/omx102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Esposito S, Bassetti M, Concia E, De Simone G, De Rosa FG, Grossi P, Novelli A, Menichetti F, Petrosillo N, Tinelli M, Tumbarello M, Sanguinetti M, Viale P, Venditti M, Viscoli C. Diagnosis and management of skin and soft-tissue infections (SSTI). A literature review and consensus statement: an update. J Chemother 2017; 29:197-214. [PMID: 28378613 DOI: 10.1080/1120009x.2017.1311398] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Skin and soft-tissue infections (SSTIs) are among the most common bacterial infections, posing considerable diagnostic and therapeutic challenges. Fourteen members of the Italian Society of Infectious Diseases, after a careful review of the most recent literature using Medline database and their own clinical experience, updated a previous paper published in 2011 by preparing a draught manuscript of the statements. The manuscript was successively reviewed by all members and ultimately re-formulated the present manuscript during a full day consensus meeting. The microbiological and clinical aspects together with diagnostic features were considered for necrotizing and not necrotizing SSTIs in the light of the most recent guidelines and evidences published in the last five years. The antimicrobial therapy was considered as well - both empirical and targeted to methicillin-resistant Staphylococcus aureus and/or other pathogens, also taking into account the epidemiological and bacterial resistance data and the availability of new antibacterial agents.
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Affiliation(s)
- Silvano Esposito
- a Department of Infectious Diseases, AOU San Giovanni di Dio e Ruggi d'Aragona , University of Salerno , Salerno , Italy
| | - Matteo Bassetti
- b Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy
| | - Ercole Concia
- c Division of Infectious Diseases, Department of Pathology , AOU di Verona, Policlinico 'G.B. Rossi' , Verona , Italy
| | - Giuseppe De Simone
- a Department of Infectious Diseases, AOU San Giovanni di Dio e Ruggi d'Aragona , University of Salerno , Salerno , Italy
| | - Francesco G De Rosa
- d Department of Medical Science , University of Turin, Infectious Diseases Amedeo di Savoia Hospital , Turin , Italy
| | - Paolo Grossi
- e Infectious Diseases Unit , University of Insubria and University Hospital 'ASST Sette Laghi' , Varese , Italy
| | - Andrea Novelli
- f Department of Health Sciences, Section of Clinical Pharmacology and Oncology , University of Florence , Florence , Italy
| | | | - Nicola Petrosillo
- h National Institute for Infectious Diseases Lazzaro Spallanzani-INMU IRCCS , Rome , Italy
| | - Marco Tinelli
- i Division of Infectious and Tropical Diseases , Hospital of Lodi , Lodi , Italy
| | - Mario Tumbarello
- j Institute of Infectious Diseases , Catholic University of the Sacred Hearth, A. Gemelli Hospital , Rome , Italy
| | - Maurizio Sanguinetti
- k Institute of Microbiology , Università Cattolica del Sacro Cuore , Rome , Italy
| | - Pierluigi Viale
- l Department of Medical Surgical Sciences , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | - Mario Venditti
- m Department of Public Health and Infectious Diseases , 'Sapienza' University of Rome , Italy
| | - Claudio Viscoli
- n Infectious Diseases Division , University of Genoa and IRCCS San Martino-IST , Genoa , Italy
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Yoshino Y, Funahashi K, Okada R, Miura Y, Suzuki T, Koda T, Yoshida K, Koike J, Shiokawa H, Ushigome M, Kaneko T, Nagashima Y, Goto M, Kurihara A, Kaneko H. Severe Fournier's gangrene in a patient with rectal cancer: case report and literature review. World J Surg Oncol 2016; 14:234. [PMID: 27585438 PMCID: PMC5009679 DOI: 10.1186/s12957-016-0989-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 08/17/2016] [Indexed: 11/17/2022] Open
Abstract
Background Fournier’s gangrene in the setting of rectal cancer is rare. Treatment for Fournier’s gangrene associated with rectal cancer is more complex than other cases of Fournier’s gangrene. We report on a patient with severe Fournier’s gangrene in the setting of locally advanced rectal cancer who was treated with a combined modality therapy. Case presentation A 65-year-old man presented with general fatigue and anal pain. The medical and surgical histories were unremarkable. A black spot on the perineal skin surrounded by erythema was found on physical examination, suspicious for Fournier’s gangrene. Computed tomography scan showed a rectal tumor invading into the bladder (clinically T4bN2M0) and abscess formation with emphysema around the rectum. He was thus diagnosed with locally advanced rectal cancer and Fournier’s gangrene with a severity index score of 12 points. We created a diverting loop colostomy of the transverse colon and performed extensive debridement of the perineum and perianal area. Fifty days later, the patient underwent radical total pelvic exenteration with sacrectomy. In addition, reconstruction of the soft tissue defect was performed using the rectus muscle, the gluteus maximus muscle, and the femoral muscle. Histopathological findings of the specimen were as follows: the tumor was a moderately adenocarcinoma with invasion to the bladder and the prostate (T4b), metastases to four resected lymph nodes (N2), and lymphovascular invasion. There were no major postoperative complications, and the patient was discharged 108 days postoperatively. Conclusions We report a rare case of locally invasive rectal cancer associated with Fournier’s gangrene. This case highlights a usual cause of Fournier’s gangrene. Physicians should be cognizant not only of the more common condition but also of the rare presentations including those associated with rectal cancer.
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Affiliation(s)
- Yu Yoshino
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
| | - Rei Okada
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Yasuyuki Miura
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Takayuki Suzuki
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Takamaru Koda
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Kimihiko Yoshida
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Junichi Koike
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Hiroyuki Shiokawa
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Mitsunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Yasuo Nagashima
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Mayu Goto
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Akiharu Kurihara
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
| | - Hironori Kaneko
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan
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Yen CH, Liu CY, Cha TL, Wu ST, Meng E, Sun GH, Yu DS, Chen HI, Chang SY, Tsao CW. Emphysematous epididymo-orchitis as a camouflage of prostate invasion secondary to rectum cancer: A case report. Medicine (Baltimore) 2016; 95:e4385. [PMID: 27472731 PMCID: PMC5265868 DOI: 10.1097/md.0000000000004385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Emphysematous epididymo-orchitis is a rare cause of acute scrotum pain characterized by gas formation within the tissue. Diabetes mellitus and recto-seminal fistula secondary to sigmoid diverticulitis are generally accepted as being responsible for this disease. However, prostate invasion secondary to rectal cancer may be considered to be a newly identified pathogenetic mechanism. Herein, we report this rare case and illustrate the pathogenesis. CASE PRESENTATION A 69-year-old man arrived at our emergency department presenting with sepsis and acute scrotal pain. Emphysematous epididymo-orchitis was diagnosed by scrotal sonography initially; however, advanced rectal cancer with prostate invasion was diagnosed by CT after a recurrent episode. An exploratory laparotomy with abdominoperineal resection and radical prostectomy were performed after neoadjuvant chemoradiotherapy. Histopathologic analysis confirmed the previous diagnosis. Emphysematous epididymo-orchitis caused by advanced rectal cancer is very rare, and our case is the first to be reported according to a literature search. Neoadjuvant chemoradiotherapy plus extended surgery can achieve a good oncological outcome. CONCLUSION This case indicated that the very rare presentation as emphysematous epididymo-orchitis caused by locally advanced colorectal cancer.
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Affiliation(s)
- Ching-Heng Yen
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
- Division of Urology, Department of Surgery, Tri-Service General Hospital, Song-Shan Branch, Taipei
| | - Chin-Yu Liu
- Department of Nutritional Science, Fu Jen Catholic University, New Taipei City
| | - Tai-Lung Cha
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Guang-Huan Sun
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Dah-Shyong Yu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Hong-I Chen
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Sun-Yran Chang
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
| | - Chih-Wei Tsao
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center
- Correspondence: Chih-Wei Tsao, Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Gung Road, Neihu District, Taipei 11490, Taiwan (e-mail: )
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31
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Ferreira L, Alexandrino H, Soares Leite J, Castro Sousa F. Locally advanced adenocarcinoma of the rectum presenting with necrotising fasciitis of the perineum: successful management with early aggressive surgery and multimodal therapy. BMJ Case Rep 2015; 2015:bcr-2015-213245. [PMID: 26677160 DOI: 10.1136/bcr-2015-213245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Colorectal cancer is a common malignant neoplasm and its treatment usually involves surgery associated, in some cases, depending on the staging, with chemoradiotherapy. Necrotising fasciitis of the perineum is a highly lethal infection of the perineum, perirectal tissues and genitals, requiring emergency surgical debridement, broad-spectrum antibiotics and control of sepsis. We present the case of a 59-year-old man with necrotising fasciitis of the perineum as the first clinical manifestation of locally advanced adenocarcinoma of the rectum, in which successful management consisted of early and aggressive surgical debridement, followed by multimodal therapy with curative intent. 2 years and 6 months after surgery the patient is well, with no evidence of local or systemic relapse.
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Affiliation(s)
- Luís Ferreira
- Department of Surgery A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of Surgery A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Faculty of Medicine, Clinica Universitária Cirurgia III, University of Coimbra, Coimbra, Portugal
| | - Júlio Soares Leite
- Department of Surgery A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Francisco Castro Sousa
- Department of Surgery A, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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