Necrotising fasciitis in a HIV positive male: An unusual indication for abdomino-perineal resection

Caird, John; Abbasakoor, F; Quill, R

doi:10.1007/bf02944351

Cited by 9 publications

(6 citation statements)

References 17 publications

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“…Many FG cases associated with perianal area may lead a serious problem of fecal contamination [4]. Besides in cases of which the rectum is seriously affected, comprehensive interventions such as abdominoperineal resection might be required [11,12]. Many surgeons suggest that colostomy is a major part of the treatment in cases requiring wide debridement.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion

et al. 2013

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In some patients of Fournier gangrene originated from perianal region, it is important to prevent fecal contamination in order to provide healing without wound infection. For this purposes, diverting colostomy or bowel management catheter methods were performed. In this study, it is aimed to carry out a comparison of prognosis and cost efficiency between diverting colostomy and bowel management catheter methods applied for preventing fecal contamination in Fournier's gangrene patients. Fourty-eight patients with diagnosis of Fournier's gangrene, serious perianal infections, and preserved sphincters and without rectum injury after debridement were included in the study. The cases were divided into two groups as patients who were subjected to colostomy for fecal diversion and who were subjected to bowel management catheter without colostomy. Then, the groups were compared in terms of age, predisposing factors, duration of hospital stay, mortality, additional surgery requirements, and cost. Fourty-eight patients were included the study. Sixteen patients were treated without colostomy. Decreased duration of total hospital stay, additional surgery requirements, and hospital expense in bowel management catheter group has determined. It is thought that preferring bowel management catheter method instead of colostomy in patients without rectum injury, who require diverting colostomy and have undamaged anal sphincters, can relieve patients, patients' relatives, healthcare organizations, and the national economy of a serious burden. In addition, although patients' satisfaction and workforce loss factors are not taken into consideration in this study, the bowel management catheter method is thought to have positive effects also on these parameters.

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Section: Discussionmentioning

confidence: 99%

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion

et al. 2013

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“…All four patients with Fournier's gangrene were men aged between 34 and 41 years. Their mean CD4 counts were 200 cells/mm 3 , compared to 350 cells/mm 3 for patients with uncomplicated peri-anal sepsis. The initial presentations included severe anal pain and fever.…”

Section: Necrotizing Peri-anal Infections In Patients With Hivmentioning

confidence: 99%

“…He also had a long-standing history of HIV treated with anti-retroviral therapy, but stopped his therapy six months previously. He had no history of opportunistic infections, and his most recent CD4 (T-cell) count taken two months prior to presentation was 460 cells/mm 3 . His CD4 count on admission to hospital was 77 cells/mm 3 .…”

Section: Casementioning

confidence: 99%

“…He had no history of opportunistic infections, and his most recent CD4 (T-cell) count taken two months prior to presentation was 460 cells/mm 3 . His CD4 count on admission to hospital was 77 cells/mm 3 . Abdominal imaging revealed intramuscular and fascial air throughout the right leg and pelvic muscles.…”

Section: Casementioning

confidence: 99%

“…Complications of peri-anal sepsis include necrotizing fasciitis of the genital area, perineum, and peri-anal region (Fournier's gangrene), and there are several case reports involving patients with HIV. [2][3][4][5] The largest series of HIV peri-anal sepsis retrospectively reviewed 50 cases over a 10-year period.…”

Section: Necrotizing Peri-anal Infections In Patients With Hivmentioning

confidence: 99%

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Acute Kidney Injury with Polyuria in a Patient with HIV

Silver¹,

Richardson²

2015

CJGIM

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SummaryWe describe the case of a 30-year-old man with HIV with an elevated creatinine and three litres per day of urine output. Using this patient as a framework, we review a diagnostic approach to acute kidney injury with polyuria. This case emphasizes the importance of a complete diagnostic evaluation of acute kidney injury. Without this approach, it would have been easy to attribute the patient's acute kidney injury to his HIV and necrotizing peri-anal infection, instead of the true lifethreatening cause. CaseA 30-year-old Caucasian man presented to hospital with fever and peri-anal abscesses. He suffered from chronic peri-anal fistulas and had previously undergone five fistulotomies. He also had a long-standing history of HIV treated with anti-retroviral therapy, but stopped his therapy six months previously. He had no history of opportunistic infections, and his most recent CD4 (T-cell) count taken two months prior to presentation was 460 cells/mm 3 . His CD4 count on admission to hospital was 77 cells/mm 3 . Abdominal imaging revealed intramuscular and fascial air throughout the right leg and pelvic muscles. There was loculated gas within the right mesorectum/presacral space. He was diagnosed with necrotizing fasciitis from a peri-rectal source and underwent a right above-knee amputation along with loop ileostomy. Cultures from the operating room later grew Streptococcus anginosis, and he was treated with appropriate antibiotics. He required several more debridements while in hospital and had a very slow convalescence. Onset of Acute Kidney InjuryWhile the patient recovered, routine blood work (complete blood cell count [CBC], electrolytes, and creatinine) was done on a weekly basis. Three months after his first surgery, his serum creatinine was noted to be 250 µmol/L from a baseline the previous week of 50 µmol/L. A nephrology consultation (which included the authors) was requested.Further history revealed that the patient was eating well with no significant gastrointestinal symptoms. His medication list included ritonavir, emtricitabine, tenofovir, atazanavir, metoprolol, cotrimoxazole prophylaxis, hydromorphone, and gabapentin. He had received no new nephrotoxic drugs such as non-steroidal anti-inflammatories or aminoglycosides. His last abdominal computed tomography (CT) scan, done three weeks earlier, reported normal-appearing kidneys.Physical examination revealed a heart rate of 80 beats per minute (BPM) and blood pressure 140/90. His jugular venous pressure was below the sternal angle when supine. His lungs were clear.

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Complications of Anal Surgery

Shorthouse¹,

Brown²

2010

Anorectal and Colonic Diseases

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Necrotising fasciitis in a HIV positive male: An unusual indication for abdomino-perineal resection

Cited by 9 publications

References 17 publications

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion

Comparison of Diverting Colostomy and Bowel Management Catheter Applications in Fournier Gangrene Cases Requiring Fecal Diversion

Acute Kidney Injury with Polyuria in a Patient with HIV

Complications of Anal Surgery

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