title: MRI can determine the adequate area for debridement in the case of Fournier's gangrene.
abstract: A 57-year-old man was transferred to our hospital because of gluteal pain. His right buttock had flare and swelling. Complete blood count showed leukocytosis, and renal failure was evident. Pelvic computed tomography (CT) revealed that the abscess, including gas, was widespread into the hypodermal tissue of the right buttock. Fournier's gangrene had been suspected, and immediate drainage was performed on the right buttock. The symptom and the condition improved rapidly, but on the day after the operation, the patient became drowsy and fell into endotoxic shock. Magnetic resonance imaging (MRI) revealed strong inflammation along the entire fascia of the right femur and necrotizing fasciitis. MRI was very useful for identification of the necrotic range. Immediately, an emergency operation was performed; 3 wide incisions were made on the right thigh and crus for drainage. The patient was cared for intensively under a sedated condition, and irrigation and debridement were repeated every day. Culture of the pus revealed mixed infection of Escherichia coli and anaerobic bacteria, and a large quantity of antimicrobial drug was used. The inflammatory reaction decreased, and the patient's general condition tentatively improved. With Fournier's gangrene, initiating adequate surgical and medical treatment is essential. Therefore, MRI should be used in the early exact diagnosis of this disease to obtain knowledge of the extent of necrosis and to determine the adequate area for debridement.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. dm06034e@cc.nagasaki-u.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Yoneda
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Fujita
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Tokai
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Masashi
authors.initials: M
authors.lastname: Haraguchi
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000473:pathology / Q000601:surgery; D018934:Fournier Gangrene / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D007507:Therapeutic Irrigation