Perforated Rectal Cancer Presenting as Fournier’s Gangrene in a Confused Older Patient

Abstract

We present the case of an eighty-two-year-old man who presented with testicular pain, diarrhoea, fresh rectal bleeding, and weight loss. A clear history was not obtained because of presumed chronic confusion secondary to age related vascular dementia. He was subsequently diagnosed with Fournier’s gangrene and a retrospective obtainment of his collateral history revealed a completely normal pre-morbid cognitive level of function. Thus, his confusion was secondary to an atypical cause of sepsis and he was managed with surgical debridement. We highlight the value of urgent computed tomography (CT) scanning as well as the use of screening tools for assessing cognitive function, particularly in surgical specialties, as well as the importance of obtaining a collateral history and discussing means for better collaborative efforts amongst surgeons and physicians in managing the “confused patient”.

Case Report on Fournier's Gangrene

“…The synergistic microbial activity results in production of various exotoxins and enzymes like collagenase, heparinase, hyaluronidase, streptokinase and streptodornase, which lead to tissue destruction and spread of infection. The aetiological factors of Fournier gangrene are obesity 9 , diabetes mellitus, abnormal sexual practices, alcohol abuse [9][10][11][12][13][14][15] , infection of gastrointestinal tract 3 , tissue ischemia [3][4][5][6][7][8][9][10][11][12] . When it comes to children the main aetiological factor is diaper rash 17 , pelvic injury, omphalitis, localised abscess, circumcision [24][25][26][27] .…”

“…When it comes to children the main aetiological factor is diaper rash 17 , pelvic injury, omphalitis, localised abscess, circumcision [24][25][26][27] . The most important predisposing factors that we encounter among the patients are age, diabetes mellitus, rectal cancer, chronic alcohol abuse, malignancy [13][14][15][16] ,parentral drug use, malnutrition, extreme ages, atrial hypertention, chemo radiotherapy [24][25][26] . Predisposing factors for mortality in patients with FG is female gender, which is due to the association with the frequent involvement of retroperitoneal and abdominal cavity in inflammatory process 13 .…”

“…This disease is infective in origin 11 . The Aetiology includes abnormal sexual practices, parentral drug abuse, trauma, insect bite, prior surgical procedures in the perenial region, burns (11)(12)(13)(14)(15)(16)(17)(18) . Predisposing factors of FG's include Diabetes Mellitus , alcoholism, immunosuppression, tobacco abuse, chemotherapy, radiography, atrial Hypertension 28,29,30 .…”

Fournier’s Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature

“…Local procedures and chronic indwelling catheters increase the risk of infection. Chemotherapy as a treatment for a previously diagnosed unrelated cancer was seen in 15% (3/20) of the case reports [3][4][5][6][7].…”