Annals of Coloproctology

Original Article

Anorectal benign disease

Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report: Jessica A. Paynter, Kirby R. Qin, Dongrong Situ, Chun Hin Angus Lee; Ann Coloproctol. 2023;39(5):421-426. Published online May 26, 2022; DOI: https://doi.org/10.3393/ac.2022.00192.0027

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Purpose
A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of such presentation.
Methods
Firstly, the report of the 56-year-old male patient is discussed regarding his surgical management. Secondly, a systematic review was undertaken according to PRISMA guidelines using MEDLINE, Scopus, and Embase databases. Searches used the following MeSH terms: (“fournier’s gangrene”) AND ((necrotising fasciitis) OR (necrotising soft tissue infection)). Once the search results were obtained, duplicate articles were removed. Titles, abstracts, and articles were reviewed by 2 authors.
Results
The search strategy using the 3 databases revealed a total of 402 studies. Fifty-seven studies were removed due to duplication. A total of 345 records were screened via title and abstract, of which 115 were excluded. Two hundred and thirty studies were reviewed for eligibility. A total of all 230 studies were excluded; 169 were excluded as they included the incorrect patient population (patients suffered from FG or NF, but not both collectively), 60 studies were excluded due to incorrect study designs, and 1 report occurred in the wrong setting.
Conclusion
This highlights that while being a relatively known, uncommon infection both FG and NF are well documented separately within the literature. However, FG with concurrent multifocal NF has not been documented within the literature.

Citations

Citations to this article as recorded by

FOURNIER'S GANGRENE: A CASE REPORT
Serhiy Morozov, Mariia Matvieienko, Tetiana Kozlova
Eastern Ukrainian Medical Journal.2024; 12(2): 448. CrossRef
Fournier's gangrene complicated by lower limb necrotising fasciitis and pelvic bone osteomyelitis: A case report with literature review
Joshua Chek Hao Foo, Ernest Junrui Lim, Alvin Yuanming Lee, Yadong Lu
International Journal of Surgery Case Reports.2024; 121: 109974. CrossRef

Case Reports

Necrotizing Fasciitis Arising From an Enterocutaneous Fistula in a Case of an Appendiceal Mucocele: Keun Young Kim, Won Cheol Park; Ann Coloproctol. 2015;31(6):246-250. Published online December 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.6.246

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Abstract PDF

An appendiceal mucocele (AM) is a rare tumorous condition of the appendix. Many patients with AM are admitted to the hospital with abdominal pain or discomfort, and many cases are found incidentally. Although the rate of complications in patients with AM is very low, if left untreated, a mucocele may rupture and produce a potentially fatal entity known as pseudomyxoma peritonei. In this paper, we report a case of an 80-year-old man with necrotizing fasciitis arising from an enterocutaneous fistula caused by AM.

Citations

Citations to this article as recorded by

Enterocutaneous fistula resulting from the drainage of a contained appendiceal perforation secondary to a partially obstructing low-grade appendiceal mucinous neoplasm
Ryan Cohen, Katie McKean, Stephanie Chetrit
BMJ Case Reports.2021; 14(8): e244546. CrossRef
Atypical presentation of appendicitis
Oliver Beaumont, Robert Miller, Richard Guy
BMJ Case Reports.2016; 2016: bcr2016217293. CrossRef

Necrotizing Fasciitis of the Thigh Secondary to Radiation Colitis in a Rectal Cancer Patient: So Hyun Park, Jung Ran Choi, Ji Young Song, Kyu Keun Kang, Woong Sun Yoo, Sung Wan Han, Choon Kwan Kim; J Korean Soc Coloproctol. 2012;28(6):325-329. Published online December 31, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.6.325

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8 Citations

Abstract PDF

Necrotizing fasciitis usually occurs after dermal injury or through hematogenous spread. To date, few cases have been reported as necrotizing fasciitis of the thigh secondary to rectal perforation in rectal cancer patients. A 66-year-old male complained of pelvic and thigh pain and subsequently developed necrotizing fasciitis in his right thigh. Four years earlier, he had undergone a low anterior resection and radiotherapy due to of rectal cancer. An ulcerative lesion had been observed around the anastomosis site during the colonoscopy that had been performed two months earlier. Pelvic computed tomography and sigmoidoscopy showed rectal perforation and presacral abscess extending to buttock and the right posterior thigh fascia. Thus, the necrotizing fasciitis was believed to have occurred because of ulcer perforation, one of the complications of chronic radiation colitis, at the anastomosis site. When a rectal-cancer patient complains of pelvic and thigh pain, the possibility of a rectal perforation should be considered.

Citations

Citations to this article as recorded by

Lower limb necrotising fasciitis descending from malignant colonic perforation: a rare pattern
Elliot Robbie, Seema Desai, Ashok Ramavath
BMJ Case Reports.2024; 17(12): e262470. CrossRef
Left thigh necrotizing fasciitis secondary to colocutaneous fistula in previously treated rectal cancer: case report of a single, late and fatal complication
Leandro SIRAGUSA, Daniele SFORZA, Bruno SENSI, Cristine PATHIRANNEHALAGE DON, Linda DE LUCA, Matteo CIANCIO MANUELLI, Barbara TOMEI, Leonardo VATTERMOLI, Massimo VILLA, Michele GRANDE
Chirurgia.2023;[Epub] CrossRef
Necrotising Myofasciitis of the Lower Limb Secondary to Extra-Peritoneal Rectal Perforation
Mohamed A Radhi, Jamie Clements
Cureus.2022;[Epub] CrossRef
Necrotizing fasciitis of the lower extremity secondary to a perforated rectosigmoid tumor
SuleymanUtku Celik, Rahman Senocak
Indian Journal of Cancer.2021; 58(4): 603. CrossRef
Thigh Pain Associated With Diarrhea
Kenneth D. Marshall, Dakota M. Williams, Bradley S. Jackson
Annals of Emergency Medicine.2019; 73(6): 577. CrossRef
ベバシズマブを含む化学療法中の直腸癌患者に発症したA群β溶連菌による壊死性筋膜炎の1例(A case of group A beta streptococcal necrotizing fasciitis in a patient with rectal cancer underwent chemotherapy including bevacizumab)
三好博実 (Hiromi Miyoshi), 大下慎一郎 (Shinichiro Ohshimo), 木田佳子 (Yoshiko Kida), 山賀聡之 (Satoshi Yamaga), 太田浩平 (Kohei Ota), 津村龍 (Ryu Tsumura), 志馬伸朗 (Nobuaki Shime)
Nihon Kyukyu Igakukai Zasshi: Journal of Japanese Association for Acute Medicine.2018; 29(1): 36. CrossRef
Unusual inguinal mass
Matthew Wei, Andrew Hardley, Raaj Chandra
ANZ Journal of Surgery.2017; 87(11): 949. CrossRef
Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer
Ju-Oh Kim, Hong-Man Cho, Woo-Jin Sin, Hwang-Se Bong
Hip & Pelvis.2013; 25(2): 149. CrossRef

Fournier's Gangrene after Excision of a Thrombosed Hemorrhoid.: Lee, Min Ro , Kim, Jong Hun , Hwang, Yong; J Korean Soc Coloproctol. 2006;22(4):276-278.

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Abstract PDF: Fournier's gangrene is a life-threatening disorder characterized by necrotizing fasciitis of the perineal region. Because delay in diagnosis and treatment of this condition can be fatal, it is important not to overlook the symptoms. We present an unusual case of Fournier's gangrene after excision of a thrombosed hemorrhoid. A previously healthy 74-year-old female patient developed Fournier's gangrene after a hemorrhoidectomy. In spite of aggressive treatment, she eventually died. Here, we emphasize early recognition and prompt treatment of this condition, reporting an unexpected disastrous complication of a hemorrhoidectomy.

Necrotizing Fasciitis of Perineum after Surgery and Radiation Therapy for Rectal Cancer.: Boo, Yoon Jung , Min, Byung Wook , Um, Jun Won , Moon, Hong Young; J Korean Soc Coloproctol. 2004;20(5):333-336.

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3 Download

Abstract PDF: Necrotizing fasciitis is a rare disease characterized by rapidly progressive soft tissue infection primarily involving the superficial fascia and is associated with significant morbidity and mortality. Necrotizing fasciitis of the genitalia and the perineum, also known as Fournier's gangrene, usually occurs after local trauma, perirectal or perineal infections, and complicated surgery, such as circumcision and herniorraphy. The lack of initial external clinical signs, because the process begins in the deep subcutaneous tissue, make early diagnosis and adequate surgical management difficult. The progression of the disease is often fulminant, and the prognosis hinges on accurate diagnosis and immediate surgical debridement. The present case report documents the rare development of fulminant necrotizing fasciitis associated with a rectal cancer surgery and radiation therapy.

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