Fournier's gangrene の1例 [in Japanese] FOURNIER'S GANGRENE : REPORT OF A CASE [in Japanese]
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陰嚢を含む会陰部に広範な重症皮膚軟部組織壊死を生じ,いわゆるFournier's gangreneと思われる極めて稀な症例を経験したので報告する.患者は59歳男性で,発熱を伴う肛門周囲の疼痛で発症した.近医にて切開排膿術を受けるも症状は軽快せず,当科に紹介入院となった.初診時,体温は38.7°Cで,肛門周囲より悪臭を伴う黄褐色の排膿が見られた.単純X線写真にて陰嚢皮下にガス像も認めた.敗血症を疑い,直ちにIVH管理下に免疫グロブリン,抗生剤投与を開始した.細菌培養ではE. coliを検出した. bed sideにて局所の切開排膿ドレナージ,デブリードマンを行うも,感染壊死巣が肛門周囲より陰茎,陰嚢,臀部におよび,両鼠径部,両背部にかけて皮膚の発赤・腫脹が進行するため,全身麻酔下で陰嚢,睾丸を含む会陰部切除,膀胱瘻造設,膿瘍広範囲切開ドレナージ術を施行した.術後の創傷治癒は良好で,術後52日目に全治退院となった.
A very rare case of Fournier's gangrene is reported. A 59-year-old male was referred to our clinic because of a perianal pain with high fever. On admission, pelvic X-ray films revealed a subcutaneous diffuse gas shadow at the scrotum. In spite of intensive chemotherapy concomitant with incisional drainage of perianal abscess, the inflammatory change extended further to the penis, scrotum, epididymis, gluteal region and bilateral inguinal regions as well. Finally, radical operation including castration, debridement, cystostomy, fistulectomy and complete abscess drainage was performed. The patient was discharged from the hospital on the 64th postoperative day without any complications. Recently, Fournier's syndrome becomes rare because of hte development of antibiotics. However, the mortality rate is still as high as 10% in Japan, especially in the patients with poor risks, such as diabetes mellitus, liver cirrhosis and alcoholism. In case suspected of Fournier's syndrome, the intensive care, including aggressive surgical drainage and debridement as well as administration of broad-spectrum antibiotics must be done as soon as possible.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 57(9), 2300-2304, 1996-09-25
Japan Surgical Association