Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

Abstract

Fournier's gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.

Severe Fournier’s gangrene in a patient with rectal cancer: case report and literature review

“…There were 23 cases evaluated in a review by Bruketa et al [2]; in Japan, 17 cases including the present case have been reported (Table 1). The median age in the Japanese group was 58 (range, 30–80) years with a male to female ratio of 15:2.…”

Emphysematous epididymo-orchitis as a camouflage of prostate invasion secondary to rectum cancer

“…[6–8] In addition, colon cancer can induce Fournier gangrene. [9,10] Therefore, the urinary tract can be affected by direct tumor invasion or tumor-associated inflammatory processes.…”

“…[11] Colorectal cancer also can induce the same inflammatory process and fistula formation. Bruketa et al [9] ever concluded that the perforated rectal cancer could induce Fournier gangrene with perineum fascia extension and absence of testis involvement. However our case presented as annular rectal cancer with prostate invasion, which hypothesized to process the development of emphysematous epididymo-orchitis through the vas deferens via backflow of gas-producing bacteria.…”

Locally advanced adenocarcinoma of the rectum presenting with necrotising fasciitis of the perineum: successful management with early aggressive surgery and multimodal therapy

“…Necrotising fasciitis of the perineum is a rare presentation of advanced rectal cancer 14. Since necrotising fasciitis is more common in elderly and immunocompromised patients, and carries high mortality,4 7 and because rectal cancer is usually in the perforated stage, aggressive curative-intent therapy is often not possible 9 13 15.…”