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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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The wound care: debridement – shown is the 11th day post-surgery.
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f5-cia-10-673: The wound care: debridement – shown is the 11th day post-surgery.

Mentions: The patient’s pathologic history presented a calcified, chronic pancreatitis as well as a pancreatic pseudocyst into which two stents were applied in order to guide its content into the stomach. During evaluation, however, only one stent was found. This suggested that the other stent might have dislocated and subsequently been eliminated (the other stent was replaced by an inflatable balloon). After 5 years, upon X-ray computed tomography (CT) examination in the urology clinic, however, a foreign structure of a length of ~10 cm was observed (his former stent from 2008) in the sigmoid colon, with double perforation and air in the peritoneal cavity as well as massive inflammation of the perivisceral structures. For stent extraction (Figure 3), a sigmoidoscopy was performed, followed by colostomy, sigmoidal anus praeter, and debridement of the scrotum and peritoneum (Figure 4); during surgery, the distal and sigmoid colon were rinsed with saline and no evidence of perforation was further noticed. Surgical necrosis removal and repeated debridement (Figure 5) under antimicrobiotic protection followed. Upon intervention, the patient was transferred from the intensive care unit to the urologic ward. Here, debridement, suprapubic catheter change, and subcutaneous testicle relocation towards the inguinal region continued (Figure 6). The patient was then released with no sign of local infection and recommendation for plastic surgery for visible defect removal was given.


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)

The wound care: debridement – shown is the 11th day post-surgery.
© Copyright Policy
Related In: Results  -  Collection

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

f5-cia-10-673: The wound care: debridement – shown is the 11th day post-surgery.
Mentions: The patient’s pathologic history presented a calcified, chronic pancreatitis as well as a pancreatic pseudocyst into which two stents were applied in order to guide its content into the stomach. During evaluation, however, only one stent was found. This suggested that the other stent might have dislocated and subsequently been eliminated (the other stent was replaced by an inflatable balloon). After 5 years, upon X-ray computed tomography (CT) examination in the urology clinic, however, a foreign structure of a length of ~10 cm was observed (his former stent from 2008) in the sigmoid colon, with double perforation and air in the peritoneal cavity as well as massive inflammation of the perivisceral structures. For stent extraction (Figure 3), a sigmoidoscopy was performed, followed by colostomy, sigmoidal anus praeter, and debridement of the scrotum and peritoneum (Figure 4); during surgery, the distal and sigmoid colon were rinsed with saline and no evidence of perforation was further noticed. Surgical necrosis removal and repeated debridement (Figure 5) under antimicrobiotic protection followed. Upon intervention, the patient was transferred from the intensive care unit to the urologic ward. Here, debridement, suprapubic catheter change, and subcutaneous testicle relocation towards the inguinal region continued (Figure 6). The patient was then released with no sign of local infection and recommendation for plastic surgery for visible defect removal was given.

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