Abstract
The life of a patient with severe Fournier gangrene associated with a high mortality rate as judged by Fournier's Gangrene Severity Index (UFGSI) was saved by extensive debridement. A 73-year-old man was brought to our hospital by ambulance because of redness of the gluteal region and pain. The skin of the perianal region and scrotum was necrotic, and the whole gluteal region was red. A computed tomography (CT) scan showed wall thickening of the lower rectum, and turbid adipose tissue was seen to the level of the right 12th rib. His diagnosis was severe Fournier gangrene caused by perforated rectal cancer, so a colostomy and perianal drainage were performed. However, even after surgery, the range of infection extended to the level of the lower edge of the scapula, and sepsis and DIC occurred (UFGSI 18). On postoperative day 8, abdominoperineal resection, vesiculectomy, orchiectomy, and debridement of his back and right femoral region were performed. He recovered from DIC and sepsis and was discharged from hospital after skin grafting. Resection of the primary lesion and extensive debridement are necessary to treat uncontrolled severe Fournier gangrene caused by perforated rectal cancer.
