doiSerbia

Recurrent Fournier's gangrene in a diabetic patient

Terzić Milan (Institut za ginekologiju i akušerstvo, Klinički centar Srbije, Beograd)
Micić Jelena (Institut za ginekologiju i akušerstvo, Klinički centar Srbije, Beograd)
Maričić Sanja (Dom zdravlja 'Savski venac', Beograd)
Arsenović Nebojša (Odsek za kožnu patologiju, Odeljenje za ćelijsku patologiju, Službe za patologiju 'Patlinks', Okružna bolnica, Linkoln, Velika Britanija)

Introduction. Fournier's gangrene (FG) is a fulminant form of infective necrotizing fascitis of the perineal, genital, or perianal regions caused by anorectal or urogenital and perineal trauma, more common in patients with diabetes mellitus and alcohol misuse. Despite contemporary management, mortality is still high and averages 20-30%. Case Outline. A 53-year-old extremely obese diabetic postmenopausal woman with the history of poorly regulated insulin-dependent diabetes mellitus lasting for 20 years, and gangrene followed by autoamputation of minor labia a year ago, was admitted due to severe suprapubic pain and septic fever. Gynaecological examination revealed suprapubic abscess spontaneously perforated few hours prior to admission. Contraincision was performed and purulent green-yellowish discharge appeared. Microbial evaluation of the obtained specimen identified Peptostreptoccocus, Enterococcus and E.coli. Antibiotics were administered according to the sensitivity test and suprapubic tumour formation was irrigated and drained. The procedure lasted seven days and resulted in the healing of the pathological process. Conclusion. FG is still a life-threatening condition; so, diagnosis should be prompt with early surgical intervention, along with antibiotics and good supportive care. Proactive management of the diabetic patient with perineal infections is of extreme importance, in order to prevent the development of FG, the entity associated with very high mortality. According to the literature data available, this is the first reported case of FG relapse.

Keywords: Fournier's gangrene, diabetes, surgical intervention, Antibiotics