[Fournier's gangrene in an HIV-positive patient. Therapeutic options].
Fournier's gangrene is a life-threatening necrotising infection of the perineal and genital regions. The case presented here refers to an HIV-positive 42-year-old man, admitted in emergency to our department with clinical signs and symptoms of sepsis related to gangrene of the perineum and scrotum. An early wide surgical necrosectomy was performed under epidural anaesthesia. Treatment was completed by intensive care, broad-spectrum antibiotics and hyperbaric oxygen therapy. The wound was managed with advanced dressing (AQUACEL Hydrofiber) until complete healing was obtained, and the scrotum was reconstructed with skin flaps. The disease did not involve the testes, spermatic cord or anorectal canal. The satisfactory aesthetic and functional outcome prompts the authors to stress a number of features of the therapeutic approach adopted: (i) the advantages of epidural anaesthesia with an indwelling catheter that allows further necrosectomy and wound dressing to be performed totally painlessly; (ii) the possibility of avoiding faecal diversion by means of synthetic opioid drugs which are useful to reduce the frequency of defecation; and (iii) the positive impact of advanced dressing on the wound healing process in relation to patient satisfaction and cost management.
Chirurgia Generale A, Dipartimento Chirurgico Materno-Infantile e Scienze delle Immagini, Ospedale San Giovanni di Dio, Università degli Studi di Cagliari, Cagliari.
Sergio
S
Licheri
Enrico
E
Erdas
Giuseppe
G
Pisano
Annalisa
A
Garau
Michela
M
Barbarossa
Anna
A
Tusconi
Mariano
M
Pomata
D000328:Adult; D018934:Fournier Gangrene / Q000209:etiology* / Q000601:surgery*; D005832:Genital Diseases, Male / Q000209:etiology* / Q000601:surgery*; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008297:Male; D010502:Perineum; D012611:Scrotum
Gangrena di Fournier in paziente HIV positivo: considerazioni terapeutiche.