Management of Fourniers gangrene secondary to perineal invasion by rectal cancer

Introduction and importance: Fournier's gangrene is a known disease process resulting in a severe necrotizing soft tissue infection involving the perineum and scrotum. Although most cases are known to be associated with diabetes (Go et al., 2010 [1]), it is rare to develop this extensive infection secondary to tumor invasion from the rectum. Treatment typically requires several debridements until infection is fully controlled. Case presentation: A 65 year old man with a history of locally invasive and unresectable rectal cancer presents to our emergency department with severe perineal and scrotal pain and was found to be in septic shock. He had previously undergone a diverting colostomy as well as radiation to the pelvis. He underwent several surgical debridements until the infection was controlled. He then required procedures to close the large defects created until complete wound healing was achieved within 3 months of presentation. Clinical discussion: This condition is associated with a high morbidity and mortality, and its management can be split in to two stages. The early phase includes resuscitation, initial debridements and likely several sequential debridements as well as fecal diversion. The late phase then involves the healing process with reconstruction efforts. A multi-disciplinary team is required for appropriate management under the direction of the general surgeon, which also include urologists, plastic surgeons and wound care nurses. Conclusion: Fournier's gangrene secondary to tumor invasion should be recognized as a potential cause other than the typical culprits. Resuscitation, antibiotics, debridements and a team approach is needed to recover from such a debilitating disease.