Rectal cancer and Fournier's gangrene - current knowledge and therapeutic options.
Fournier's gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.
Tomislav Bruketa, Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia.
Tomislav
T
Bruketa
Tomislav Bruketa, Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia.
Matea
M
Majerovic
Tomislav Bruketa, Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia.
Goran
G
Augustin
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant; D003125:Colostomy; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures; D018934:Fournier Gangrene / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D011237:Predictive Value of Tests; D019651:Plastic Surgery Procedures; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Fournier’s gangrene; Necrotizing fasciitis; Necrotizing soft tissue infections; Oncological treatment; Proctological examination; Reconstructive surgery; Rectal cancer; Surgical treatment