title: A clinical case of Fournier gangrene.
abstract: OBJECTIVE
  To present a case of Fournier gangrene and the specific surgical therapy
  
  
  METHODS
  A 71-year old patient with a two days history of pain in the perineal region, swelling, developing necrosis and foul-smelling lesions was examined in emergency settings. The swelling of subcutaneous plane involved the flank regions, mainly on the left side. The investigations were performed (full blood count, blood urea, electrolytes, coagulation profile). A Fournier gangrene was diagnosed and surgery performed under general anesthesia. Broad spectrum antibiotics were given concomitantly. The first surgical procedure consisted in surgical debridement and excision of all the necrotic tissue. Cultures were taken. We performed counter incisions bilaterally on both flanks. The communication through the fascial planes was clearly demonstrated, especially on the left side. A loop colostomy was also performed. Multiple re-excisions were further employed. Due to a precarious evolution, the patient were on mechanical ventilation for 13 days. Inotrope medication was given for a total of 19 days and, the antibiotherapy adapted to the antibiogram (Bacterioides eggerthii was identified). The reconstruction of the perineum was later performed and, after 3 months, the colostomy was closed in good conditions without further complications.
  
  
  CONCLUSIONS
  Early recognition and aggressive surgical excision are mandatory for success in patients with Fournier gangrene. Colonic diversion can be very useful if employed from the beginning.
authors.affiliation: Department of Surgery, Bucharest Emergency Hospital, Romania. florinmd@hotmail.com
authors.forename: F M
authors.initials: FM
authors.lastname: Iordache
authors.forename: M
authors.initials: M
authors.lastname: Beuran
authors.forename: C
authors.initials: C
authors.lastname: Turculeţ
authors.forename: C
authors.initials: C
authors.lastname: Vasilescu
authors.forename: D
authors.initials: D
authors.lastname: Surdeanu
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001439:Bacteroides / Q000302:isolation & purification*; D001442:Bacteroides Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D003125:Colostomy; D003646:Debridement / Q000379:methods; D042241:Early Diagnosis; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010502:Perineum / Q000473:pathology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents