Prague Med. Rep. 2021, 122, 39-44

https://doi.org/10.14712/23362936.2021.5

Challenging Treatment of a Female Patient with Extensive Fournier’s Gangrene – Case Report

Ognen Kostovski1, Olivera Spasovska1, Gjorgji Trajkovski1, Svetozar Antovic1, Irena Kostovska2, Katerina Tosheska-Trajkovska2, Biljana Kuzmanovska3, Sofija Pejkova4, Nikola Jankulovski1

1University Clinic of Abdominal Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
2Department of Medical Biochemistry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
3University Clinic of Traumatology, Orthopedic Disease, Anesthesiology, Reanimation and Intensive Care Medicine and Emergency Department, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia
4University Clinic of Plastic and Reconstructive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, North Macedonia

Received June 16, 2020
Accepted January 28, 2021

Fournier’s gangrene (FG) is a necrotizing fasciitis of the genital, perianal and perineal regions, caused by multiple anaerobic/aerobic infection. It is a rare but very serious condition with multiple long-term complications and high mortality rate. Early diagnosis and multidisciplinary approach in treatment of complicated cases of FG are crucial to the successful outcome. We report a case of an extensive FG in a 59-years-old female patient with multiple risk factors such as obesity, type 2 diabetes and hypertension. She was hospitalized as an emergency case with diabetic ketoacidosis, sepsis and extensive necrotic lesions located perineal, perianal, genital and spread to inguinal, hypogastric, gluteal and sacrococcygeal region. Fournier’s gangrene was diagnosed, and after prompt resuscitation, intravenous fluids, broad-spectrum antibiotics, insulin infusion, emergency aggressive surgical debridement was performed. Several aerobic and anaerobic bacteria were isolated from wound culture and hemoculture. Patient has second debridement after four days. After second debridement was applied metabolic control, broad-spectrum antibiotics coverage, dressing the wound and negative pressure wound therapy (NPWT). Patient was discharged home five weeks after a second debridement in good condition. One month later she underwent reconstructive surgical treatment. Besides extensive FG and multiple comorbidity she was successfully managed with good outcome. Fournier’s gangrene remains a life-threatening and fulminant disease which need urgent diagnosis and aggressive medical and surgical treatment, to achieve a reduction in long term complications and mortality rate.

References

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