Pictures in oncology

NOWOTWORY Journal of Oncology

2022, volume 72, number 3, 200

DOI: 10.5603/NJO.2022.0026

© Polskie Towarzystwo Onkologiczne

ISSN 0029–540X, e-ISSN: 2300-2115

www.nowotwory.edu.pl

Rectal cancer as a rare cause of Fournier's gangrene

Michał Kisielewski1Anna Mydłowska2Michał Nowakowski3
1Chair of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
2Department of Surgery, University of Alabama, Birmingham, United States
3II Department of General Surgery, Collegium Medicum, Jagiellonian University, Krakow, Poland

How to cite:

Kisielewski M, Mydłowska A, Nowakowski M. Rectal cancer as a rare cause of Fournier's gangrene. NOWOTWORY J Oncol 2022; 72: 200.

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

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

References

  1. Klement RJ, Schäfer G, Sweeney RA. A fatal case of Fournier’s gangrene during neoadjuvant radiotherapy for rectal cancer. Strahlenther Onkol. 2019; 195(5): 441–446, doi: 10.1007/s00066-018-1401-4, indexed in Pubmed: 30470845.
  2. Błaszkowski T, Celban G, Domagała M, et al. Surgical treatment of rectal cancer in Poland – a report from a prospective, multi-centre observational study PSSO_01 conducted under the auspices of the Polish Society of Surgical Oncology. Nowotwory. Journal of Oncology. 2018; 68(3): 118–126, doi: 10.5603/njo.2018.0019.

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