Combination of substance addiction and Fournier’s gangrenia: a case report

Yıl 2024, , 143 - 145, 15.01.2024

Doğan Öztürk , Bülent Öztürk , Sibel Özkara , Raşit Levent Mermer

https://doi.org/10.32322/jhsm.1316174

Öz

Fournier's gangrene is a bacterial and rapidly progressive necrotizing fasciitis of the perianal and perineal region. It still has high morbidity and mortality. We aimed to present Fournier's gangrene, which developed in a 49-year-old male patient with substance abuse. The patient was brought to the emergency department with complaints of abdominal pain and pain in the perineum and perianal region on the 3rd day after foreign body trauma to the perianal region. Crepitation was detected under the skin in the suprapubic region of the patient. Acute abdomen was present in the abdominal examination. In the abdominal tomography, minimal fluid was detected between the bowel loops in the pelvis. Diffuse edema, heterogeneity and emphysematous changes were observed in the skin and subcutaneous tissues in the perineum, and in the rectus muscle of the anterior abdominal wall. The patient underwent an emergency laparotomy. Abscess material extending from the back of the rectus muscle to the pelvis was seen in the abdomen. Abscess and necrotic areas in the abdomen and perineum were cleaned. A protective Hartman end colostomy was opened to the patient. In the postoperative period, VAC was applied to the perianal region for 3 sessions with 72 hour intervals. Then, the wound in the perineum was closed primarily. After 3 months, his colostomy was taken into the abdomen. Early and aggressive surgical debridement, broad-spectrum antibiotics, and fluid resuscitation are critical in Fournier's gangrene. Because of this patient's late admission to the hospital and his long-term immunosuppression associated with substance abuse, his clinical condition deteriorated rapidly. It should be kept in mind that skin infections in the perianal region may progress to Fournier's gangrene in patients with conditions that may cause immunosuppression, such as substance abuse.

Anahtar Kelimeler

Fournier, substance abuse, necrotizing fasciitis

Kaynakça

• Ghodoussipour SB, Gould D, Lifton J, et al. Surviving Fournier's gangrene: Multivariable analysis and a novel scoring system to predict length of stay. J Plast Reconstr Aesthet Surg. 2018;71(5):712-718. doi: 10.1016/j.bjps.2017.12.005.
• Althunayyan S, Karamitosos E. Fournier's gangrene in an obese female in third trimester of pregnancy. Saudi Med J. 2018;39(4):415-418. doi: 10.15537/smj.2018.4.21780
• Sugihara T, Yasunaga H, Horiguchi H, et al. Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases. BJU Int. 2012;110(11 Pt C):1096-1100. doi: 10.1111/j.1464-410X.2012.11291.x
• Sorensen MD, Krieger JN, Rivara FP, et al. Fournier's gangrene: population based epidemiology and outcomes. J Urol. 2009;181(5):2120-2126. doi: 10.1016/j.juro.2009.01.034
• Aksel G, Özel BA, Kavalcı C, Muratoğlu M. Diabetes mellitusu olan bir kadın hastada Fournier Gangreni: bir olgu sunumu. JAEMCR. 2014;5:206-208 doi:10.5152/jaemcr.2014.392
• Al Shukry S, Ommen J. Necrotizing fasciitis-report of ten cases and review of recent literature. J Med Life. 2013;6(2):189-194.
• Taylor GM, Hess DV. Fournier gangrene: a rare case of necrotizing fasciitis of the entire right hemi-pelvis in a diabetic female. Oxf Med Case Reports. 2018;2018(2):omx094. doi: 10.1093/omcr/omx094