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Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report.

Schulz D, Mohor GS, Solovan C - Clin Interv Aging (2015)

Bottom Line: After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene.FG that has spread to the male genital organs presents therapeutic challenges.The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.

View Article: PubMed Central - PubMed

Affiliation: Sana Kliniken Leipziger Land, Klinik fur Urologie, Borna, Leipzig, Germany.

ABSTRACT
Fournier gangrene (FG) is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.

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Severe necrosis of patient’s scrotum and perineum.
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f1-cia-10-673: Severe necrosis of patient’s scrotum and perineum.

Mentions: A 59-year-old patient presented himself in August 2013 at the Clinic of Urology Helios Leipziger Land with decreased general well-being, somnolent, cachexia, arterial hypotension, heart rate of 90 bpm, respiratory frequency of 25 per minute, and urinary incontinence. Upon clinical tegument examination, severe necrosis of the scrotum and perineum were found (Figure 1). The necrosis had spontaneously perforated, presenting a smell suggesting moist gangrene (Figure 2). Laboratory parameters suggested an inflammatory syndrome (hemoglobin [mmd/L]: 6.7; 5.3; 5.5; 4.8; 5.1; leukocytes [Gpt/L]: 9.8; 9.5; 22.5; 11; 10.6; fibrinogen [g/L]: 8.7; >9; 7.7; 6.3; 4.5; 6; C-reactive protein [mg/L]: 327; 298; 87; procalcitonin [μg/L]: 7.24; 4.62; 2.2; 0.51; 0.34; partial thromboplastin time [seconds]: 42.3), and the microbiologic tests indicated a colonization of Bacteroides pyogenes, Staphylococcus haemolyticus, Escherichia coli, Clostridium innocuum, Enterococcus faecium, Enterococcus faecalis, Candida albicans, and non-albicans Candida. Enterococcus faecium was sensitive for macrolide-lincosamide-streptogramin, glycylcycline, and the glycopeptide class of antibiotics and resistant to beta-lactam antibiotic, aminoglycoside antibiotic, and the fluoroquinolone drug class. At the clinical general examination, an injury of the right lumbar plexus was observed. Based on clinical appearance and laboratory results, a diagnosis of FG was established.


Unusual foreign body in the sigmoid colon, chronic alcohol abuse, and Fournier gangrene: a case report.

Schulz D, Mohor GS, Solovan C - Clin Interv Aging (2015)

Severe necrosis of patient’s scrotum and perineum.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388072&req=5

f1-cia-10-673: Severe necrosis of patient’s scrotum and perineum.
Mentions: A 59-year-old patient presented himself in August 2013 at the Clinic of Urology Helios Leipziger Land with decreased general well-being, somnolent, cachexia, arterial hypotension, heart rate of 90 bpm, respiratory frequency of 25 per minute, and urinary incontinence. Upon clinical tegument examination, severe necrosis of the scrotum and perineum were found (Figure 1). The necrosis had spontaneously perforated, presenting a smell suggesting moist gangrene (Figure 2). Laboratory parameters suggested an inflammatory syndrome (hemoglobin [mmd/L]: 6.7; 5.3; 5.5; 4.8; 5.1; leukocytes [Gpt/L]: 9.8; 9.5; 22.5; 11; 10.6; fibrinogen [g/L]: 8.7; >9; 7.7; 6.3; 4.5; 6; C-reactive protein [mg/L]: 327; 298; 87; procalcitonin [μg/L]: 7.24; 4.62; 2.2; 0.51; 0.34; partial thromboplastin time [seconds]: 42.3), and the microbiologic tests indicated a colonization of Bacteroides pyogenes, Staphylococcus haemolyticus, Escherichia coli, Clostridium innocuum, Enterococcus faecium, Enterococcus faecalis, Candida albicans, and non-albicans Candida. Enterococcus faecium was sensitive for macrolide-lincosamide-streptogramin, glycylcycline, and the glycopeptide class of antibiotics and resistant to beta-lactam antibiotic, aminoglycoside antibiotic, and the fluoroquinolone drug class. At the clinical general examination, an injury of the right lumbar plexus was observed. Based on clinical appearance and laboratory results, a diagnosis of FG was established.

Bottom Line: After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene.FG that has spread to the male genital organs presents therapeutic challenges.The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.

View Article: PubMed Central - PubMed

Affiliation: Sana Kliniken Leipziger Land, Klinik fur Urologie, Borna, Leipzig, Germany.

ABSTRACT
Fournier gangrene (FG) is an infectious condition with fulminant evolution and is sometimes life-threatening. Here, we present the case of an immunocompromised 59-year-old male with surgical history of a pancreatic pseudocyst stented endoscopically. After unrecognized stent migration in the sigmoid without colonic perforation, he developed severe necrosis of the scrotum and perineum, which spontaneously perforated, presenting a smell suggesting moist gangrene. FG that has spread to the male genital organs presents therapeutic challenges. The purpose of our study is to present this case, typical for FG, with an educational aim both for the internal and surgical specialties, and the goal of further multidisciplinary collaboration for the optimal management of the patient with personalized treatment.

Show MeSH
Related in: MedlinePlus