Extraperitoneal Surgical Approach in Two Cases of Fournier Syndrome with Extensive Pelvic and Retroperitoneal Abscesses

Abstract

Fournier syndrome is a rare and life-threatening infectious disease. We present two cases of Fournier syndrome in which the infectious and necrotizing tissues extended into the pelvic cavity and retroperitoneum. In both cases, the focus of the fulminant infection was a periproctal abscess. CT scans demonstrated extensive gas and inflammatory exudate and abscesses in the ischiosacral space, pelvic cavity and retroperitoneal space. Urgent aggressive surgeries were performed. Under general anesthesia, the pelvic abscesses were drained using an extraperitoneal approach through a lower abdominal skin incision. Necrotizing fascia in the retroperitoneal space or ischiosacral space was resected through a large skin incision. To prevent fecal contamination of the perineal soft tissue defect, a diverting colostomy was constructed in both patients. After surgery, systemic antibiotic administration and wound irrigation were performed. In conclusion, the drainage of intrapelvic abscesses and the resection of retroperitoneal necrotizing fascia, using an extraperitoneal approach through a lower abdominal skin incision is beneficial in patients with Fournier syndrome.