直腸癌に Fournier's gangrene を合併した1例 [in Japanese] A CASE OF FOURNIER'S GANGRENE WITH RECTAL CANCER [in Japanese]
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Fournier's gangreneは会陰部に発生する劇症型の感染性壊疽で早急に治療を施さないと予後不良な経過をたどる疾患である．直腸癌にFournier's gangreneを合併した報告は稀であり，自験例が本邦で9例目の報告である．<BR>症例は会陰部に広範な黒色の壊死が出現し，Fournier's gangreneと診断された60歳男性である．入院翌日に人工肛門造設術，創部のデブリードマンを施行，術後は連日創洗浄し，創の肉芽化を促した．CTで直腸Rb後方に壁肥厚像，大腸内視鏡検査では直腸Rbに全周性の隆起性病変を認められ，生検では高分化腺癌と診断された．しかし，経過中にMRSA敗血症となり，根治手術に至らずに永眠された．<BR>Fournier's gangreneに直腸癌を合併している場合の治療方針は感染供給源の根絶と癌の根治性の2方面からの治療を考慮する必要があると考えられた．
Fournier's gangrene is a specific type of fasciitis caused by an infection of the perianal tissue and progresses rapidly and widely. This disease is a poor risk factor for survival and its treatment is very difficult. We report a case of Fornier's gangrene wirh rectal cacner.<BR>A 60-year-old man was admitted to the hospital because of a high fever and perianal pain. His perineum was filled with black necrotic tissue. On the next day after admission, radical debridement, lavage and drainage were done, and sigmoid colostomy was established for fecal diversion. After that operation, the wound was washed by shower water every day to control local infection. A few days later, pelvic composed tomography revealed wall thickening of the rectum due to rectal cancer, and colonoscopy showed a rectal tumor which was diagnosed as well differentiated adenocarcinoma histologically. Unforturatly, he died of septic shock caused by MRSA before radical operation.<BR>In treating Fournier's gangrene with rectal cancer, therapeutic guidelines must be constituted from both angles of extermination of infection source and radical treatment for cancer. We experienced a case of advanced rectal cancer presented with a perianal abscess progressing to extended Fournier's gangrene. Our case is the sixth report in Japan. Further accumulation of reports and lively discussions of this disease are anticipated.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 69(7), 1823-1827, 2008-07-25
Japan Surgical Association