直腸癌に合併したFournier's gangreneの1例

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  • A CASE OF FOURNIER'S GANGRENE ASSOCIATED WITH RECTAL CANCER

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A patient with Fournier's gangrene associated with advanced rectal cancer who could not be saved because of rapidly deteriorated course is reported. A 75-year-old man complaining of tarry stool revealed apple core sign in the rectum Rb on a barium enema study, and was admitted to the hospital with a diagnosis of rectal cancer. At a digital examination of the rectum, a whole-circumference tumor was palpated. No perianal abnormalities were noted, but swellings in the same region and scrotum were confirmed and incision drainage was performed. Two days later a swelling with crackling sensation covering from the perineum to right lateral abdominal region continuously appeared. Emergency operation was performed where an incision drainage and a removal of necrosed tissues were performed. The patient was associated with postoperative disseminated intravascular coagulation (DIC) and consequent adult respiratory distress syndrome (ARDS), and was managed by artificial respiration. But the patient's condition deteriorated and died on the 6th postoperative day.<br> There have been only one domestic case and two foreign cases in which Fournier's gangrene was associated with rectal cancer before operation as far as we could review. In all cases, rectal cancers perforated the rectal wall and this direct invasion of cancer caused perianal abscess.

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