Rectal cancer as a rare cause of Fournier's gangrene

Abstract

Not available

Fournier’s gangrene (FG) is a rapidly progressive infection due to invasion of aerobic and anaerobic bacteria. Patient presents with septic shock [1]. Fournier’s gangrene in a rectal cancer setting is very rare [2]. We report a patient with severe FG as a first presentation of locally advanced rectal cancer. An 86-year-old man was brought to the emergency room due to discolouration of the scrotal region and a decrease in mental status. At admission the patient there was necrotic swelling with black discolouration of the scrotum and perianal region (fig. 1) with subcutaneous emphysema. Per rectum examination revealed multiple anterior fistulas with a bleeding mass noted right above the margin of the anus. The patient was qualified for emergency surgery. Surgery revealed a pelvic mass without signs of metastatic disease to the peritoneum. A diverting sigmoid colostomy was created. Urological intervention consisted of bilateral orchiectomy with extensive debridement of the scrotum and perianal region (fig. 2). A suprapubic cystostomy was also created. Patient was discharged home with a colostomy bag in a good general state after a total hospital stay of 27 days. The histopathological report revealed infiltrative adenocarcinoma G2 with angioinvasion. Scrotal and testicular specimen revealed necrosis of the scrotum and oedema and fibro-pustular infiltration of the testes.

Figure 1. Fournier's gangrene prior to surgery

Figure 2. View after surgical debridement