A Severe Case of Fournier’s Gangrene Treated by Team Approach and Multidisciplinary Cooperation

Abstract

A 75–year–old diabetic male patient on chemotherapy for inoperable gastric cancer was admitted to our hospital with fever and perineal pain. On admission, the skin of the perineum was partially disintegrated, with extensive rubor. Blood examination revealed evidence of a severe inflammatory reaction, and abdominal–pelvic CT revealed the dirty fat sign from the anus to the rectus abdominis muscle. With the diagnosis of septic shock complicating Fournier’s gangrene, an emergency debridement operation was performed by a multidisciplinary team. Since the necrotic area expanded after the first operation, laparoscopic sigmoid colostomy and percutaneus cystostomy with additional debridement were performed on Day 12. After bilateral orchiectomy and thigh muscle flap reconstruction performed on Day 46, the patient was discharged on Day 85. Fournier’s gangrene is a progressive necrotizing fasciitis that can become complicated by multi–organ dysfunction; therefore, intensive treatment from the early stage with collaboration among multiple departments by a multidisciplinary approach is necessary to save the life of the patient and return him/her earlier to the society.