title: Severe Fournier's gangrene in a patient with rectal cancer: case report and literature review.
abstract: BACKGROUND
  Fournier's gangrene in the setting of rectal cancer is rare. Treatment for Fournier's gangrene associated with rectal cancer is more complex than other cases of Fournier's gangrene. We report on a patient with severe Fournier's gangrene in the setting of locally advanced rectal cancer who was treated with a combined modality therapy.
  
  
  METHODS
  A 65-year-old man presented with general fatigue and anal pain. The medical and surgical histories were unremarkable. A black spot on the perineal skin surrounded by erythema was found on physical examination, suspicious for Fournier's gangrene. Computed tomography scan showed a rectal tumor invading into the bladder (clinically T4bN2M0) and abscess formation with emphysema around the rectum. He was thus diagnosed with locally advanced rectal cancer and Fournier's gangrene with a severity index score of 12 points. We created a diverting loop colostomy of the transverse colon and performed extensive debridement of the perineum and perianal area. Fifty days later, the patient underwent radical total pelvic exenteration with sacrectomy. In addition, reconstruction of the soft tissue defect was performed using the rectus muscle, the gluteus maximus muscle, and the femoral muscle. Histopathological findings of the specimen were as follows: the tumor was a moderately adenocarcinoma with invasion to the bladder and the prostate (T4b), metastases to four resected lymph nodes (N2), and lymphovascular invasion. There were no major postoperative complications, and the patient was discharged 108 days postoperatively.
  
  
  CONCLUSIONS
  We report a rare case of locally invasive rectal cancer associated with Fournier's gangrene. This case highlights a usual cause of Fournier's gangrene. Physicians should be cognizant not only of the more common condition but also of the rare presentations including those associated with rectal cancer.
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Yu
authors: Y
authors: Yoshino
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan. kingkong@med.toho-u.ac.jp.
authors: Kimihiko
authors: K
authors: Funahashi
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Rei
authors: R
authors: Okada
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Yasuyuki
authors: Y
authors: Miura
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Takayuki
authors: T
authors: Suzuki
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Takamaru
authors: T
authors: Koda
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Kimihiko
authors: K
authors: Yoshida
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Junichi
authors: J
authors: Koike
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Hiroyuki
authors: H
authors: Shiokawa
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Mitsunori
authors: M
authors: Ushigome
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Tomoaki
authors: T
authors: Kaneko
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Yasuo
authors: Y
authors: Nagashima
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Mayu
authors: M
authors: Goto
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Akiharu
authors: A
authors: Kurihara
authors: Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Ota-Ku, Tokyo, 143-8541, Japan.
authors: Hironori
authors: H
authors: Kaneko
mesh_terms: D000368:Aged; D018934:Fournier Gangrene / Q000150:complications / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D011379:Prognosis; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery
keywords: Fournier’s gangrene; Reconstructive surgery; Rectal cancer; Surgical treatment