SUMMARYWe present the case of an 82-year-old Caucasian lady with a 16-day history of colicky lower abdominal pain and reduced appetite. When presenting to hospital she was haemodynamically stable with no fever. Examination revealed a soft but tender abdomen with normal bowel sounds. No masses or hernias were present. Per-rectal examination revealed an empty rectum. Investigations showed raised inflammatory markers, white cell count 11.9 and C reactive protein 24, in addition to which she had dilated loops of small and large bowel on the abdominal radiograph. The patient underwent an emergency laparotomy where a mass in the descending colon was found to be intussuscepting into the proximal sigmoid colon for which a Hartmanns procedure was performed. Histopathology confirmed a Dukes B T3 N0 Mx adenocarcinoma.
BACKGROUND
SUMMARYThe development of Fournier's gangrene in an 80-year-old male patient with diabetes after a routine outpatient haemorrhoid banding procedure is described. Four days following the procedure, the patient noticed an increasing amount of pain and swelling of the perianal region. When the patient presented to the emergency department 18 days later, immediate radical debridement of ischiorectal necrotic tissue was performed. A defunctioning loop sigmoid colostomy was also formed. Subsequent operations required excision of the scrotum and abdominoperineal excision of the rectum. Histology studies later confirmed the presence of necrotising fasciitis. The case acts as a reminder that clinicians should maintain a high index of suspicion for high-risk patients still suffering from problems following the procedure.
BACKGROUND
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