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. 2018 Sep 26;4(1):123.
doi: 10.1186/s40792-018-0526-0.

Fournier's gangrene caused by penetration of a rectal cancer followed by neoadjuvant chemotherapy

Daigo Kobayashi  1 , Mariko Masubuchi  2 , Tsunenobu Takase  2 , Takahiro Ichikawa  2 , Tomohiro Deguchi  2 , Toyohisa Yaguchi  2
Affiliations

Fournier's gangrene caused by penetration of a rectal cancer followed by neoadjuvant chemotherapy

Daigo Kobayashi et al. Surg Case Rep. .

Abstract

Background: Fournier's gangrene is a necrotizing fasciitis of the genital and perineal region. It may progress, affecting the groin, the thigh, or even the abdominal wall. Despite adequate treatment (debridement and antibiotics), the mortality rate is very high, reaching 20-35%. Fournier's gangrene caused by penetration of a rectal cancer followed by neoadjuvant chemotherapy is very rare. We report this case with a review of the literature.

Case presentation: A 68-year-old man visited the emergency room due to perineal pain during which he accepted the chemotherapy for locally advanced rectal cancer. Abdominal CT scan showed extensive emphysema in the scrotum and gluteus maximus muscle. We diagnosed as Fournier's gangrene caused by penetration of a rectal cancer. We performed debridement, left orchiectomy, transverse colostomy with double orifices. Post-operative day 30, we performed abdominoperineal resection. We performed CapeOX therapy eight courses as adjuvant chemotherapy. The patient had no recurrence for 1 year and 2 months after the operation.

Conclusions: Going forward, knowledge gained from this case will increase the opportunity to perform neoadjuvant chemotherapy for locally advanced rectal cancer. In medical treatment, we must put the possibility of Fournier's gangrene in mind and treat as soon as possible.

Keywords: Fournier’s gangrene; Locally advanced rectal cancer; Neoadjuvant chemotherapy.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for the publication of this case report and any accompanying images.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Barium enema showed the apple core sign at the rectum below the peritoneal reflection (arrow)
Fig. 2
Fig. 2
a The left-sided lateral lymph nodes were swollen (arrow). b Fat concentration was increased
Fig. 3
Fig. 3
The perineum and scrotum was swollen
Fig. 4
Fig. 4
Extensive emphysema in the scrotum and gluteus maximus muscle
Fig. 5
Fig. 5
Debridement, left orchiectomy, transverse colostomy with double orifices (a). We cleaned the wound every day (b). The granulation tissue was formed (c)
Fig. 6
Fig. 6
Resected specimen (a). Histological effect judgment was grade 1a (RECIST v1.1) (b)
Fig. 7
Fig. 7
Cleaned the wound every day (a). At discharge (b). Healing (c)
See this image and copyright information in PMC

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