A multistep approach to manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report

Journal of Medical Case Reports

Antonio Carbone³  Vincenzo Petrozza¹  Davide Moschese²  Cristina Maggioni²  Domenico Autieri²  Antonino Leto²  Luigi Silvestri²  Andrea Ripoli²  Giovanni Palleschi³  Antonio Luigi Pastore³ 

[1] Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy;Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, ICOT, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Via Franco Faggiana 1668, Latina, 04100, Italy;Uroresearch Association, a non-profit association for urology research, Latina, Italy

关键词: Vacuum-assisted closure;    Necrotizing fasciitis;    Hyperbaric oxygen therapy;    Fournier’s gangrene;    Diabetes mellitus;   

Others  :  1195160
DOI  :  10.1186/1752-1947-7-1

 received in 2012-08-22, accepted in 2012-11-08,  发布年份 2013

【 摘 要 】

Introduction

Fournier’s gangrene is an infectious necrotizing fasciitis of the perineum and genital regions and has a high mortality rate. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms and predisposing factors, including diabetes mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a case of Fournier’s gangrene in a patient with unknown type II diabetes submitted to 24-hour catheterization 15 days before gangrene onset.

Case presentation

The patient, a 60-year-old Caucasian man, presented with a swollen, edematous, emphysematous scrotum with a crepitant skin and a small circle of necrosis. A lack of resistance along the dartos fascia of the scrotum and Scarpa’s lower abdominal wall fascia combined with the presence of gas and pus during the first surgical debridement also supported the diagnosis of Fournier’s gangrene. On the basis of the microbiological culture, the patient was given multiple antibiotic therapy, combined hypoglycemic treatment, hyperbaric oxygen therapy, and several surgical debridements. After five days the infection was not completely controlled and a vacuum-assisted closure device therapy was started.

Conclusions

This report describes the successful multistep approach of an immediate surgical debridement combined with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted closure is a well-known method used to treat complex wounds. In this case study, vacuum-assisted closure treatment was effective and the patient did not require reconstructive surgery. Our report shows that bladder catheterization, a minimally invasive maneuver, may also cause severe infective consequences in high-risk patients, such as patients with diabetes.

【 授权许可】

   
2013 Pastore et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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