Fournier gangrene: what’s new in treatment?

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (3) ◽  
Author(s):  
Zbigniew Tański ◽  
Zbigniew Jarząbek ◽  
Bartosz Konowalski ◽  
Maciej Truszkowski ◽  
Jakub Biedrzycki ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Medical Literature ◽  
Abdominal Cavity ◽  
Tissue Necrosis ◽  
Improve Treatment ◽  
Fournier Gangrene ◽  
Soft Tissue Necrosis ◽  
Life Threatening ◽  
Perineal Region ◽  
Balanced Crystalloid

Fournier gangrene is necrotic, life-threatening fasciitis occurring in the perineal region and within external sexual organs and anus. It may extend to the abdominal cavity, leading to soft tissue necrosis and sepsis. The article presents current methods of diagnosis and treatment of necrotising fasciitis (Fournier gangrene being a part of this disease) based on the medical literature and experience of two urological wards. The following methods are discussed: isotonic salt and balanced crystalloid fluids, antibiotics, steroids, immunoglobulin, hyperbaric oxygen therapy, surgical debridement and split-thickness mesh grafting. At the beginning broad spectrum antibiotics were administrated for the patients, according with local guidelines therapeutic committee and results of specimens for Gram’s staining and culture and laboratory tests. After receiving antibiogram prompt antibiotic treatment was continued. Cystostomy was done for everyone. Active dressing was applied rarely. Mortality was not observed in this group of patients. Fournier gangrene frequently ends with death due to sepsis, ARDS, or insufficiency of the kidneys, liver or other organs. Early diagnosis, careful debridement and application of a proper antibiotic are the basic factors that reduce mortality and improve treatment outcomes.

Venomous Bites and Stings

2018 ◽  
Author(s):  
J Patrick Walker
Keyword(s):  
Significant Morbidity ◽  
Tissue Necrosis ◽  
Black Widow ◽  
Significant Treatment ◽  
The Us ◽  
Bites And Stings ◽  
Life Threatening ◽  
Compartment Pressures ◽  
Widow Spider

Approximately 8000 persons are bitten by venomous snakes in the US each year.  Mortality is low (4 to 6/yr), but morbidity can be significant, treatment costly. Overuse of surgery and antivenom is common. Simply cutting the wound with attempted aspiration is not indicated. Fasciotomy should only be used for patients with elevated compartment pressures. CroFab is a highly effective (but expensive) treatment useful for serious envenomation. Antivenom should be used in patients with life-threatening symptoms (hypotension, clinical coagulopathy) or rapid advancement of local signs, and to reduce compartment pressures to avoid fasciotomy. The most significant morbidity from insect envenomation is secondary to anaphylaxis. A bite from the black widow spider can induce abdominal cramping and pain that can mimics an acute abdomen. Brown recluse envenomation can produce tissue necrosis and long-term complications. Most events are seen rarely by the average physician; this review can be a useful guide in management.  Key words: antivenom, copperhead bite, CroFab, insect bite, rattlesnake bite, snakebite, water moccasin bite

Progressive Soft-Tissue Necrosis

JAMA Surgery ◽  
2014 ◽  
Vol 149 (2) ◽  
pp. 211
Author(s):  
Jane H. Kim ◽  
Stephen Somach ◽  
Christopher R. McHenry
Keyword(s):  
Soft Tissue ◽  
Tissue Necrosis ◽  
Soft Tissue Necrosis

scholarly journals Diagnostic difficulties and features of endovideosurgical treatment of a patient with mucocele of the appendix

2020 ◽  
Vol 12 (2) ◽  
pp. 85-90
Author(s):  
Badri V. Sigua ◽  
Vyacheslav P. Zemlyanoy ◽  
Elguja L. Lataria ◽  
Alexey A. Kurkov ◽  
Vyacheslav A. Melnikov ◽  
...  
Keyword(s):  
Benign Tumor ◽  
Abdominal Cavity ◽  
Clinical Manifestations ◽  
Vermiform Appendix ◽  
Diagnostic Methods ◽  
Number Of Patients ◽  
Mucocele Of The Appendix ◽  
Diagnostic Difficulties ◽  
Life Threatening ◽  
The Right

The mucocele of the appendix is the expansion of the appendix with the accumulation of a large amount of mucus. The mechanism and causes of mucocele are not fully understood. According to some authors, such changes in the appendix can occur due to cicatricial narrowing of the lumen of the appendix, compression or blockage of its base. Other authors believe that the mucocele of the appendix is a benign tumor that develops from the remnants of primitive mesenchyme and is sometimes prone to malignancy. Clinical manifestations of mucocele of the appendix are nonspecific. In a number of patients, this disease causes pain in the right abdomen, more often pulling, intermittent. However, the disease is often asymptomatic. In this regard, diagnosis is established only during performing an operation, most often, regarding acute appendicitis. Nevertheless, instrumental diagnostic methods such as ultrasound and computed tomography of the abdominal and pelvic organs make it possible to suspect mucocele. Despite the frequent asymptomatic, non-aggressive course, a number of life-threatening complications can become the outcome of the mucocele of the vermiform appendix. The most formidable complication is the rupture of the appendix with mucus entering free abdominal cavity, followed by the development of peritoneal pseudomyxoma due to implantation of mucus-forming cells. The only option for radical treatment of the mucocele of the appendix is a surgical intervention. A presented clinical case demonstrates the difficulties of diagnosis, as well as the features of surgical treatment of a patient with a mucocele of the appendix.

scholarly journals On the question of the treatment of uterine blood tumors

2020 ◽  
Vol 11 (4) ◽  
pp. 403-417
Author(s):  
Gr. N. Egorov
Keyword(s):  
Blood Vessel ◽  
Whole Blood ◽  
Total Mass ◽  
Lymphatic System ◽  
Blood Clot ◽  
Abdominal Cavity ◽  
The Body ◽  
Long Time ◽  
Life Threatening

The abdominal cavity is, in essence, an appendage of the lymphatic system, therefore, it cannot represent a completely foreign container for the blood poured out here. Indeed, the observations of Virchow, Wintrich and others show that whole blood can remain in this cavity for a long time (several days) without undergoing clotting (Pashutin). In view of this fact, it is natural to expect, as is confirmed by experiments, that most of the blood that has entered the abdominal cavity has time to be absorbed before it begins to coagulate. If a part of it, which failed to be absorbed in time, undergoes clotting, then this does not represent any particular disturbances in the overall economy of blood, the blood clot is completely absorbed after preliminary disintegration (fat). In this sense, hemorrhage into the abdominal cavity is not life-threatening, since the blood does not disappear for the body, but soon again, almost entirely, enters the total mass of the blood vessel.

scholarly journals Endometriosis as a Reason of Intraabdominal Bleeding in Pregnancy. Clinical Case

2019 ◽  
Vol 23 (3) ◽  
pp. 283-289
Author(s):  
Y. A. Revzoeva ◽  
E. Y. Shakurova
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Laboratory Tests ◽  
Clinical Case ◽  
Abdominal Cavity ◽  
Diagnostic Procedures ◽  
Reproductive Period ◽  
Diagnostic Methods ◽  
Dark Blood ◽  
Abdominal Bleeding

The article defines the significance and relevance of the problem of endometriosis during pregnancy. 10% of women in the reproductive period have different localization of endometriosis. 25% of pregnancies with endometriosis are complicated by preterm labor. The article presents a clinical case of intra-abdominal bleeding in a 28-year-old pregnant woman with retrocervical endometriosis at gestation age of 32 weeks and 6 days. The article covers the results of examination and special diagnostic procedures of intra-abdominal bleeding in pregnant women with retrocervical endometriosis. The main diagnostic methods were the study of past medical history, ultrasound examination, and laboratory tests. Due to their infrequency during pregnancy internal bleedings present difficulties in their diagnosis. Ultrasound reliably revealed a large amount of fluid in the abdominal cavity and small pelvis and excluded the presence of intrauterine bleeding. Clinical and laboratory tests indicated the severity of the patient's condition. Symptoms of moderate fetal distress were also identified. Therefore, a decision was made about an emergency delivery by the cesarean section followed by an abdominal revision. During the cesarean section, 500 ml of blood in the form of dark blood clots was found in the abdominal cavity. The condition of the premature newborn was in conformity with his gestational age. The source of bleeding were the of endometriosis on the back wall of the uterus. These focuses most likely caused hemoperitoneum. The revision of the abdominal cavity did not find any other foci of bleeding. The postoperative period was uneventful. The article provides general guidelines for the management of pregnant women with severe forms of endometriosis.

scholarly journals Successful Management of Rhabdomyolysis with Acute Infection Resulting from Chronic Sacrococcygeal Pressure Ulcers in a Paraplegic Patient: A Case Report

2020 ◽  
Author(s):  
Kai Huang ◽  
Yansheng Zhu
Keyword(s):  
Physical Examination ◽  
Laboratory Tests ◽  
Pressure Ulcers ◽  
Acute Infection ◽  
Case Presentation ◽  
The Past ◽  
Sacrococcygeal Region ◽  
Skin Sensation ◽  
Life Threatening ◽  
Paraplegic Patient

Abstract Background: Rhabdomyolysis, a potentially life-threatening syndrome, is caused by the breakdown of skeletal muscle cells and leakage of intramyocellular contents into the bloodstream. The treatment of cases with rhabdomyolysis resulting from chronic sacrococcygeal pressure ulcers have been rarely reported.Case presentation: A 62-year-old man suffered from high fever and dark-colored urine. For the past 30 years, the patient has lived with paraplegia, which led to his immobility. According to his physical examination, the wound on his sacrococcygeal region was dehisced and exuded repeatedly with loss of skin sensation. Upon corroboration of a physical examination and laboratory tests, the patient was diagnosed with rhabdomyolysis with an acute infection resulting from sacrococcygeal pressure ulcers. We first debrided the necrotic tissue, and then the chronic ulcer was repaired. The wound dressing was changed frequently, and antimicrobial therapy and nutritional support were included in the treatment. The fever and dark-colored urine were gradually relieved post-operatively. Renal function was also improved according to the typical indicators in laboratory tests. Additionally, the size of the pressure ulcers was reduced, to some extent. The patient was discharged after one month of hospitalization.Conclusions: Accurate diagnosis is critical for clinicians to administer precise treatment to paraplegic patients with progressive rhabdomyolysis.

Skin and Soft Tissue Necrosis Following Hymenoptera Sting

2003 ◽  
Vol 7 (2) ◽  
pp. 133-135 ◽  
Author(s):  
U?ur Ko�er ◽  
Yi?it �zer Tiftikcio?lu ◽  
Hasan Mete Aksoy ◽  
�nder Karaaslan
Keyword(s):  
Soft Tissue ◽  
Tissue Necrosis ◽  
Soft Tissue Necrosis ◽  
Hymenoptera Sting

PROTETIVE COLOSTOMY IN FOURNIER’S GANGRENE

2020 ◽  
Vol 7 (1) ◽  
pp. 62-65
Author(s):  
Lucas Yago Souza Schmidt ◽  
DOWGLAS PEREIRA DE OLIVEIRA ◽  
Constância Madami Nzonzi Canda ◽  
Ellen Cristina Ferreira Peixoto ◽  
Pedro Manuel Gonzalez Cuellar
Keyword(s):  
Public Hospital ◽  
Abdominal Cavity ◽  
Chronic Alcoholism ◽  
Fournier’S Gangrene ◽  
Protective Measure ◽  
Mechanical Trauma ◽  
Invasive Procedures ◽  
Fournier's Gangrene ◽  
Perineal Region ◽  
Women And Children

Fournier's Gangrene is a rapidly evolving polymicrobial necrotizing fasciitis of the perineal, perianal, and genital region, extending to the thigh root, abdominal wall and retroperitoneum, which rarely affects women and children, with an overall incidence rate of 1,6 cases per 100,000 men / year and a peak incidence after the age of 50. Incomplete hygiene, exacerbated skin folds, mechanical trauma, prolonged catheterization and invasive procedures, as well as comorbidities such as diabetes mellitus, smoking, obesity, chronic alcoholism, hypertension, immunosuppression, HIV, cancer patients, and chronic diseases are factors that predispose to the appearance of the lesion.The objective of the study is to report the case of a female patient, 43 years old, without comorbidities, with a picture of Fournier's gangrene in the perineal region and genitalia, accompanied by the General Surgery Service of the General Public Hospital of Palmas - TO, and submitted to colostomy in a descending loop as a protective measure of choice for the spread of the infection to the abdominal cavity, interrupting the progression of the disease.

Review on Mucormycosis

2021 ◽  
Vol 9 (07) ◽  
pp. 401-407
Author(s):  
Deepthi Somarouthu ◽  
Vasantha Thota ◽  
Kalyani Ampolu
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Bone Marrow ◽  
Species Level ◽  
Tissue Necrosis ◽  
Uncontrolled Diabetes ◽  
Life Threatening ◽  
Anti Fungal ◽  
Pcr Targeting ◽  
Nose And Throat

Mucormycosis is a opportunistic fungal infection that occurs in patients who are immunocompramised. The fungus causing mucormycosis belongs to the class of zygomycetes and the order of mucorales. It is highly life-threatening mycotic infection that is characterised by angioinvasion, infarction, and tissue necrosis. The risk factors include uncontrolled diabetes mellitus in ketoacidosis, various forms of metabolic acidosis, treatment with corticosteroids, organ or bone marrow transplantation etc. The diagnosis is challenging and treatment should start as early as possible to decrease mortality. Diagnosis is based on symptoms such as, in case of sinusitis, sinus biopsies are required. Ear, nose and throat endoscopy should be done. Molecular identification of mucormycosis can help in confirming diagnosis and identify the fungus from genus to species level. Different techniques are as follows: DNA probes targeting 18S subunit, ITS1 sequencing after PCR with pan-fungal primers, 18S-targeted semi-nested PCR and real time PCR targeting cytochrome b gene. The therapeutic approach should be multimodal including anti-fungal agents, surgical debridement, and correction of underlying symptoms predisposing the patient to disease.

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