Anatolian Journal of Emergency Medicine
Yazarlar: Mehmet Muzaffer İSLAM, Gökhan AKSEL, Serken Emre EROĞLU
Konular:Tıp
Anahtar Kelimeler:Fournier gangrene,Diabetes mellitus,Emergency medicine,Case series
Özet: Aim Fournier's gangrene is a bacterial necrotizing fasciitis of genital, perineal and perianal regions. The mortality of Fournier gangrene is still high in recent years. In this case report, we aimed to present two Fournier's Gangrene cases in two diabetic male patients, 41 and 56 years old respectively. Case Presentations A 41-year-old male patient was brought to the emergency room with pain and hyperemia in the right inguinal region. A hyperemic and edematous area with subcutaneous necrosis and subcutaneous crepitation were detected in the right inguinal region of the patient. Computered tomography revealed organized infection areas with subcutaneous air densities in the right inguinal region. Daptomycin 1x500mg, meropenem 3x1g and clindamycin 3x900mg IV were administered and debridement of necrotizing areas was performed to the patient. After two more wound debridement operations and 17 days of hospitalization the patient was discharged. A 56-year-old male patient was brought to the emergency room with pain and hyperemia in the right inguinal region. Physical examination revealed edema, tenderness, hyperemia and deterioration of the skin integrity in the scrotal examination. IV 1x500mg daptomycin, 3x1g meropenem, 3x450mg clindamycin were administered to the patient and was operated for debridement. The patient was discharged from the hospital with a total of two debridement operations and one month of hospitalization. Conlusion The key to successful outcomes in Fournier's gangrene cases is the correct clinical skepticism, aggressive and early surgical debridement, broad spectrum antibiotherapy, fluid resuscitation and early multidisciplinary organization. The patients discussed in this case report were classified as type 1 necrotizing fasciitis and were discharged with appropriate antibiotherapy and surgical debridement therapy. The fact of both patients being young and diabetic is related to the presence of this disease in immunocompromised patients. Emergency physicians should be aware of the skin infections in the perianal areas of patients with immunosuppressive diseases such as diabetes mellitus and these infections may rapidly progress to Fournier's Gangrene.