Asian Journal of Case Reports in Surgery

Role of Laparoscopic Loop Sigmoid Colostomy in a Case of Fournier’s Gangrene with Parietal Wall Abscess and Complex Perineopelvic Fistula Causing Pelvic Sepsis

Gradlin Roy *

Arunai Medical College and Hospital, Thiruvannamalai, India.

B. Elangovan

Arunai Medical College and Hospital, Thiruvannamalai, India.

P. Sirisha

Tagore Medical College and Hospital, Chennai, India.

*Author to whom correspondence should be addressed.

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Abstract

Background: Fournier’s gangrene is a rapidly progressive necrotizing fasciitis of scrotum and perineal region. The cornerstone of treatment is early detection, aggressive surgical debridement along with complete drainage of abscess and also optimal medical management.

Methods: This patient with Fournier's gangrene who underwent emergency surgical debridement and abscess drainage, followed by serial debridements in our institution had an unusual presentation. Because of constant fecal contamination of the wound along with development of multiple fistulous tract communicating to anterior abdominal wall and pelvis, there was ascending infection leading to pelvic sepsis and parietal wall abscess. Hence MR Fistulogram and Pelvis was recommended. The patient was successfully managed by Laparoscopic loop sigmoid for control of sepsis and faster recovery. In this patient, Laparoscopic mobilization and exteriorization of the sigmoid loop through widening the left utility port incision was found to be simple and easily reproducible technique in creating loop sigmoid colostomy. The operative time for our case was 65 minutes, making it feasible even for the surgeon without extensive laparoscopy experience.

Results: Postoperatively patient had a faster recovery, wound infection settled and secondary suturing of the wound was done. Patient was discharged for later colostomy reversal.

Conclusion: In our experience we found that patient with Fournier gangrene and complex perineal wound causing pelvic sepsis can be managed with laparoscopic fecal diversion for sepsis control and faster wound recovery

Keywords: Fournier's gangrene, complex perineal wound, perineopelvic fistula, pelvic abscess, laparoscopic loop sigmoid colostomy

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References

Jayatunga A, Caplan S, Paes T. Survival after retroperitoneal necrotizing fasciitis. British J Surg. 1993;80(8):981-981.

Available:https://doi.org/10.1002/bjs.1800800813

Yanar H, Taviloglu K, Ertekin C, et al. Fournier’s gangrene: Risk factors and strategies for management. World J Surg. 2006;30(9):1750–54.

Avery L, Scheinfeld MH. Imaging of penile and scrotal emergencies. RadioGraphics. 2013; 33:721.

Available:https://doi.org/10.1148/rg.333125158

Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier’s gangrene. Therapeutic Advances in Urology. 2015;7(4):203–15.

Akcan A, Sozuer E, Akyildiz H, Yilmaz N, Kucuk C, Ok E. Necessity of preventive colostomy for Fournier's gangrene of anorectal region Turkish J Trauma Emerg Surg. 2009;15(4):342-46.

Pini Prato A, Castagnola E, Micalizzi C, Dufour C, Avanzini S, Pio L, et al. Early diverting colostomy for perianal sepsis in children with acute leukemia. Journal of Pediatric Surgery. 2012;47(10):23–7.

Haque P, Singh N, Upadhyay S, Chaudhry N. Laparoscopic versus open sigmoid loop colostomy: A comparative study from a cohort of 62 patients requiring temporary faecal diversion at a tertiary care center in North India. Nigerian J Surg. 2019;25(2):139.-45.

Doi: 10.4103/njs.NJS_13_19.

Trejo-Ávila ME, Valenzuela-Salazar C, Betancourt-Ferreyra J, Fernández-Enríquez E, Romero-Loera S, Moreno-Portillo M. Laparoscopic versus open surgery for abdominal trauma: a case-matched study. J Laparoendosc Adv Surg Tech. 2017;27:383–7.

Doi: 10.1089/lap.2016.0535