Expansion of Fournier's gangrene into the preperitoneal space: rare case report

초록

Fournier's gangrene is a rare type of necrotizing fasciitis that causes damage to the perianal soft tissue and can lead to rapid deterioration and death. Therefore, it is important to diagnose this disease through examination with early clinical suspicion. In addition, when a diagnosis is made, appropriate debridement and broad-spectrum antibiotic treatment for the suspected area are continuously performed. In particular, if surgical debridement does not proceed widely in lesions accompanied by necrosis, it can lead to an increase in mortality. A 59-year-old woman with underlying hypertension was referred for Fournier's gangrene following abscess incision and drainage for perianal abscess. The patient did not have any previous history of coloanal procedure or instrumentation. She developed symptoms and when she visited the local emergency department, her Sequential Organ Failure Assessment (SOFA) score was 0 and there was no fever. However, when she was transferred to the hospital 4 days after incision and drainage, she had a fever of 38.1, a SOFA score of 1, and an APHACHE score of 9%. Her vital signs were blood pressure 132/84, heart rate 71, respiratory rate 20, SP02 98% in room air, and BT 38.1. Computed Tomography (CT) performed 4 days after the onset of symptoms confirmed abscess with gas formation extending from the perianal to the left lower quadrant of the abdomen. She immediately started massive irrigation and emergent incision and drainage (Pfannenstiel incision to preperitoneal space through abdomen fascia), Penrose insertion, and broad-spectrum antibiotics of meropenem plus vancomycin. The patient was transferred from the intensive care unit to the ward on post operative date 5 and was discharged on 16 post operative date after improvement. Fournier's gangrene is a devastating and life-threatening condition that requires immediate action. Along with emergency surgical debridement, it is important to rapidly administer broad spectrum antibiotics and bloc