title: Fournier's gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient.
abstract: Fournier's gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation) requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier's gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified. Subsequently, the patient underwent scheduled cecostomy closure (right hemicolectomy), while the scrotum trauma healed with tertiary intention. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier's gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development.
authors.affiliation: First Department of Surgery and Transplant Unit, Evaggelismos General Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadimitriou
authors.forename: Maria
authors.initials: M
authors.lastname: Koukoulaki
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vardas
authors.forename: Alkis
authors.initials: A
authors.lastname: Grigorakis
authors.forename: Vasileios
authors.initials: V
authors.lastname: Vougas
authors.forename: Spiros
authors.initials: S
authors.lastname: Drakopoulos
mesh_terms: D002425:Cautery / Q000009:adverse effects*; D002432:Cecum / Q000293:injuries* / Q000601:surgery; D003404:Creatinine / Q000097:blood; D018934:Fournier Gangrene / Q000209:etiology* / Q000276:immunology / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery
chemical_list: D003404:Creatinine