Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene

Okumura, Kenji; Kubota, Tadao; Nishida, Kazuhiro; Lefor, Alan Kawarai; Mizokami, Ken

doi:10.1155/2017/2062157

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…Apart from the study by Gülen et al [ 26 ], the terms ‘rhomboid’ and ‘diamond’ referred to an identical flap shape [ 2 , 13 , 14 , 15 , 23 , 27 ]. While several studies reported the outcomes of the house flap for AS [ 2 , 16 , 18 , 32 , 34 , 35 ], a smaller number described those of a rectal advancement flap [ 7 , 25 , 31 ], anal advancement flap [ 4 ], V–Y flap [ 7 , 36 ] or C‐plasty [ 20 ]. Eight studies reported early experience with more technically demanding operations, but these were limited to one to three cases [ 4 , 14 , 21 , 22 , 24 , 29 , 37 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences

et al. 2022

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Aim:The optimal surgical treatment for anatomical anal stenosis (AS) remains to be determined. The aim of this study was to determine the rates of complications and recurrence after anoplasty for anatomical AS and, wherever feasible, compare the outcomes for the various techniques. Method: A PROSPERO-registered systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Medline, PubMed, Embase, Cochrane Library of Systematic Review, Scopus and Web of Science were searched for articles published up to May 2021. Studies that assessed the outcomes of anoplasty in adult patients with anatomical AS were selected. The primary outcomes were complications and recurrence. The methodological quality of studies was appraised using the Joanna Briggs Institute critical appraisal tools. Results: From the total of 2705 unique screened records, 151 were assessed for eligibility. Only 29 studies (two prospective) met the inclusion criteria, reporting data on 556 patients [mean age 53 (18-83) years, 46% female]. Previous history of surgery for haemorrhoidal disease accounted for three quarters of cases. A total of 14 types of anoplasty were found, with the Y-V flap being the most performed technique [27% of cases (n = 149)]. Complications frequently occurred, with a pooled prevalence of 10.2% (95% CI 3.9%-24.1%) after Y-V flap and 11.5% (5.3%-23.0%) after rhomboid/diamond flap. Patients undergoing house flap achieved better results in terms of clinical improvement, satisfaction and quality of life compared with Y-V flap and rhomboid/diamond flap. Whenconsidering only studies with at least 12 months of follow-up, the pooled prevalence of recurrence was 4.7% (2.2%-9.8%), with significantly higher rates observed in the prospective versus retrospective series [pooled prevalence 18.9% (11.5%-29.5%) vs. 3.6%(1.7-7.8%), respectively; p < 0.001].

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Section: Resultsmentioning

confidence: 99%

Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences

et al. 2022

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“…Okumura K et al, have reported the only other case report of complete anal stenosis following Fournier's gangrene debridement [5].…”

Section: Discussionmentioning

confidence: 99%

Anoplasty for Fused Anus Following Fournier’s Gangrene Debridement: a Case Report

Muniandy

Henry

Sim

2021

SN Compr. Clin. Med.

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Anal stenosis is a rare debilitating surgical condition. The severity and level of the impacted region determines the management options. Numerous tension free anoplasty techniques and its varying success rates have been reported. A patient-tailored anoplasty approach depending on the severity, location, and extent of anal stenosis is rudimentary. We present a case of fused anus following extensive surgical debridement for Fournier's Gangrene. Colonoscopy illumination guided neo-anal creation was performed, which resulted in low severe anal stenosis six weeks later. Subsequently, Y-V anoplasty, lateral internal sphincterotomy, and colostomy closure were done which showed good initial recovery. However, six months later, the anal stenosis recurred, for which diamond-shaped anoplasty was offered but patient had refused any further surgical intervention. The clinical management challenge and learning experience is shared within the report.

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“…With regard to the anorectal region, this infection occurs when hemorrhoidal fistulae are present. [4] Treatment may involve Thiersch operation for rectal prolapse, [5] hemorrhoid treatment, [6][7][8][9] or chemotherapy or chemoradiotherapy for patients with rectal cancer. [10,11] Fournier's gangrene is frequently accompanied by an underlying systemic disease, diabetes mellitus, and heavy alcohol consumption [12,13] ; other causes include leukemia [14,15] and the human immunodeficiency virus.…”

Section: Introductionmentioning

confidence: 99%

Development of Fournier’s gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report

Nonaka,

Kawase,

Takagi

et al. 2024

Medicine

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Background: Fournier’s gangrene usually occurs when a specific bacterium intrudes into soft tissue, causing a wound or tumor. We encountered a patient with Fournier’s gangrene due to severe myelosuppression after chemotherapy, despite the absence of an initial lesion on the anus and rectum. Case presentation: A 54-year-old man with a left testicular cancer recurrence had undergone chemotherapy. He had asymptomatic hepatitis and high hepatitis B virus DNA levels, which were normalized by administering tenofovir alafenamide fumarate. Twelve days after the start of chemotherapy, he complained of severe pain around the anus. The following day, he went into septic shock. Visual inspection showed dark purple skin discoloration on the left side of the anus. Laboratory data revealed severe neutropenia. Computed tomography showed a high density of soft tissue on the left side of the anus and gas bubbles in the left femoral ring. We diagnosed the patient with Fournier’s gangrene due to a severe immunosuppressive state resulting from chemotherapy. We emergently removed necrotic tissue to the fullest extent possible. However, because the patient was in severe sepsis status, careful management in the intensive care unit was required for 32 days. After the first emergency operation, we performed several additional excisions. Finally, 391 days after the initial surgery, the patient was discharged from our hospital. The tumor has not recurred, and he is under outpatient observation in the urology department. Conclusion: Fournier’s gangrene should be considered in patients who are in a severe myelosuppressive state due to chemotherapy, have normal hepatitis B virus DNA levels but high hepatitis B surface antigen after tenofovir administration, complain of severe pain in the perianal area, and have a dark purple skin discoloration around the anus, despite having no initial anorectal lesions.

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Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene

Cited by 8 publications

References 5 publications

Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences

Anoplasty for anatomical anal stenosis: systematic review of complications and recurrences

Anoplasty for Fused Anus Following Fournier’s Gangrene Debridement: a Case Report

Development of Fournier’s gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report

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