Abdominoperineal Resection with Absorbable Mesh Repair of Perineal Defect for Fournier’s Gangrene: A Case Report
Authors Holden J, Nayak JG, Botkin C, Helewa RM
Received 1 December 2020
Accepted for publication 13 February 2021
Published 26 February 2021 Volume 2021:14 Pages 133—138
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Ronald Prineas
James Holden,1,2 Jasmir G Nayak,1,2 Colin Botkin,1,2 Ramzi M Helewa1,2
1Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; 2St. Boniface Hospital, Winnipeg, Manitoba, Canada
Correspondence: Ramzi M Helewa Email [email protected]
Background: Fournier’s gangrene (FG) is a rare but deadly form of necrotizing fasciitis involving the genital, perineal, and anorectal region. Risk factors include diabetes mellitus, immunosuppression, and alcohol misuse. Because multisystem organ failure can rapidly develop, early diagnosis is critical. Treatment includes fluid resuscitation, broad-spectrum antibiotics, and surgical debridement. Uncommonly, extension of perineal infection into adjacent organs can necessitate multivisceral resection, which can make reconstruction a challenge. Even with swift diagnosis and optimal treatment, morbidity and mortality are high.
Case Presentation: A 66-year-old male with a history of diabetes mellitus presented to the emergency department with progressive scrotal pain, swelling, and perineal skin changes. Examination revealed necrosis of the scrotal soft tissues with involvement of the anal canal and rectum. The patient was initiated on intravenous fluids and broad-spectrum antibiotics, then brought immediately to the operating room where surgical care was provided by a urologist, colorectal surgeon, and general surgeon with expertise in complex mesh repair. Extension of necrotic changes travelling proximally through the full thickness of the rectum was noted. The patient underwent extensive scrotal and perineal debridement, laparotomy, abdominoperineal resection (APR), end colostomy, and polyglactin mesh repair of the resultant pelvic floor defect. The patient had appropriate return of bowel function and satisfactory healing of the perineum postoperatively but ultimately died after a ventricular fibrillation-related cardiac arrest precipitated by a flare of idiopathic pulmonary fibrosis.
Conclusion: Early diagnosis and referral to the appropriate specialists are essential elements of managing FG. Here we present a case with extension of necrotizing soft tissue infection into the rectum, requiring pelvic dissection and APR as well as absorbable mesh use to aid in perineal closure. Despite expedient treatment, poor outcomes with this condition are unfortunately common.
Keywords: necrotizing fasciitis, perineal closure, absorbable mesh
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