Limits...
Fournier's gangrene after adult male circumcision.

Galukande M, Sekavuga DB, Muganzi A, Coutinho A - Int J Emerg Med (2014)

Bottom Line: On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft.At 4 months, the scrotal defect had completely closed.These are the first descriptions in the VMMC era.

View Article: PubMed Central - HTML - PubMed

Affiliation: International Hospital Kampala, Namuwongo P.O. Box 8177, Kampala, Uganda.

ABSTRACT

Background: In the advent of mass voluntary medical male circumcision (VMMC) for the partial prevention of HIV, previously rare adverse events associated with adult male circumcision are likely to be encountered with higher frequency. Fournier's gangrene, defined as a polymicrobial necrotizing fasciitis of the perineal, perianal or genital areas, is one such rare and life-threatening adverse event. In this report, we present two cases that were identified in the context of a VMMC programme over a 3-year period during which approximately 100,000 adult circumcisions were performed.

Case presentations: Case 1: A 19-year-old male who had VMMC performed using the dorsal slit technique developed pain and blisters on the scrotal skin on the sixth postoperative day. He had no co-morbidities, and serology for HIV was negative. On examination, locally he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. Repeated aggressive debridement was done while he stayed in a hospital for 3 weeks; at which point, he had healthy granulation tissue and was free of infection. The wound had closed spontaneously and completely by the fifth month. Case 2: A 52-year-old male who had VMMC performed with the sleeve resection method developed pain and swelling of the penis and scrotum on the fourth postoperative day. He had a low-grade fever of 37.6°C. He was not diabetic or immunosuppressed and had a negative HIV serology. He was admitted and was given IV antibiotics, and repeated aggressive debridement was performed. On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft. At 4 months, the scrotal defect had completely closed.

Conclusion: Fournier's gangrene is a rare occurrence after adult male circumcision with associated high morbidity. These are the first descriptions in the VMMC era.

No MeSH data available.


Related in: MedlinePlus

A picture of case report 1 on day 19.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4306070&req=5

Figure 2: A picture of case report 1 on day 19.

Mentions: A 19-year-old male with no underlying illnesses developed pain and blisters on the scrotal skin 6 days after VMMC using the dorsal slit technique. On examination, he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. On admission, he had a normal random blood sugar, Hb 11.2 g%, white cell count of 5,200 with 74% neutrophils and HIV serology was negative. Culture and sensitivity (C&S) results showed no bacterial growth/isolates. Though the patient had prior antibiotics on the way to the hospital, he was administered with intravenous fluid and broad spectrum antibiotics (ceftriaxone and metronidazole). An initial debridement was done to remove all devitalized tissues (see Figure 1), and subsequently repeated aggressive debridement was performed on the first week of admission. He developed an abscess over the left inguinal area that was incised with 500 cc of pus was drained over 4 days. At the end of the 3-week period in a hospital (see Figure 2), he had healthy granulation tissue and was free of infection. Wound care with dressing changes every 3 to 4 days (see Figure 3) were conducted until there was spontaneous wound closure 5 months later (see Figure 4).


Fournier's gangrene after adult male circumcision.

Galukande M, Sekavuga DB, Muganzi A, Coutinho A - Int J Emerg Med (2014)

A picture of case report 1 on day 19.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4306070&req=5

Figure 2: A picture of case report 1 on day 19.
Mentions: A 19-year-old male with no underlying illnesses developed pain and blisters on the scrotal skin 6 days after VMMC using the dorsal slit technique. On examination, he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. On admission, he had a normal random blood sugar, Hb 11.2 g%, white cell count of 5,200 with 74% neutrophils and HIV serology was negative. Culture and sensitivity (C&S) results showed no bacterial growth/isolates. Though the patient had prior antibiotics on the way to the hospital, he was administered with intravenous fluid and broad spectrum antibiotics (ceftriaxone and metronidazole). An initial debridement was done to remove all devitalized tissues (see Figure 1), and subsequently repeated aggressive debridement was performed on the first week of admission. He developed an abscess over the left inguinal area that was incised with 500 cc of pus was drained over 4 days. At the end of the 3-week period in a hospital (see Figure 2), he had healthy granulation tissue and was free of infection. Wound care with dressing changes every 3 to 4 days (see Figure 3) were conducted until there was spontaneous wound closure 5 months later (see Figure 4).

Bottom Line: On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft.At 4 months, the scrotal defect had completely closed.These are the first descriptions in the VMMC era.

View Article: PubMed Central - HTML - PubMed

Affiliation: International Hospital Kampala, Namuwongo P.O. Box 8177, Kampala, Uganda.

ABSTRACT

Background: In the advent of mass voluntary medical male circumcision (VMMC) for the partial prevention of HIV, previously rare adverse events associated with adult male circumcision are likely to be encountered with higher frequency. Fournier's gangrene, defined as a polymicrobial necrotizing fasciitis of the perineal, perianal or genital areas, is one such rare and life-threatening adverse event. In this report, we present two cases that were identified in the context of a VMMC programme over a 3-year period during which approximately 100,000 adult circumcisions were performed.

Case presentations: Case 1: A 19-year-old male who had VMMC performed using the dorsal slit technique developed pain and blisters on the scrotal skin on the sixth postoperative day. He had no co-morbidities, and serology for HIV was negative. On examination, locally he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. Repeated aggressive debridement was done while he stayed in a hospital for 3 weeks; at which point, he had healthy granulation tissue and was free of infection. The wound had closed spontaneously and completely by the fifth month. Case 2: A 52-year-old male who had VMMC performed with the sleeve resection method developed pain and swelling of the penis and scrotum on the fourth postoperative day. He had a low-grade fever of 37.6°C. He was not diabetic or immunosuppressed and had a negative HIV serology. He was admitted and was given IV antibiotics, and repeated aggressive debridement was performed. On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft. At 4 months, the scrotal defect had completely closed.

Conclusion: Fournier's gangrene is a rare occurrence after adult male circumcision with associated high morbidity. These are the first descriptions in the VMMC era.

No MeSH data available.


Related in: MedlinePlus