Asian Journal of Case Reports in Surgery

A Novel Approach to a Rare Case of Fournier’s Gangrene Involving the Space of Retzius

Ong Jianming Calvin *

Department of General Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.

Amanda See Huimin

Department of General Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.

Ramesh Wijaya

Department of General Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.

Sulaiman Bin Yusof

Department of General Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.

*Author to whom correspondence should be addressed.

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Abstract

Fournier’s gangrene is a type of necrotizing fasciitis involving the perineal, perianal or genital areas that is rapidly progressive and life-threatening. Treatment involves urgent surgical debridement as well as antibiotic therapy. We report a rare case of Fournier’s gangrene of the perianal region which extended up the left pararectal and paravesical space to involve the space of Retzius. This was managed in a novel and minimally invasive approach which avoided the need for a laparotomy and its associated morbidity.

Keywords: Fourniers, retzius, minimally, invasive

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References

Stevens DL, Baddour LM. Necrotizing soft tissue infections. Up To Date; 2020. Available:www.uptodate.com

Wang J-M, Lim H-K. Necrotizing fasciitis: Eight-year experience and literature review. Braz J Infect Dis. 2014;18(2):137–143.

Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med. 2017;377 (23):2253–2265.

Wessels MR. Streptococal infections. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill. 2012:1176.

Pastore AL,PalleschiG,RipoliA,et al. A multi-step approach to manage Fournier’s gangrene in a patient with unknown typeII diabetes: surgery, hyperbaric oxygen,and vacuum assisted closure therapy: a case report. JMed Case Rep. 2013;7:1.

Nawijn F, Smeeing DPJ, Houwert RM, Leenen LPH, Hietbrink F. Time Is of the essence when treating necrotizing soft tissue infections: A Systematic Review and Meta-Analysis. World J. Emerg. Surg. 2020;15:4. DOI: 10.1186/s13017-019-0286-6

Urbina T, Hua C, Sbidian E, Bosc R, Tomberli F, Lepeule R, Decousser JW, Mekontso Dessap A, Chosidow O, de Prost N, et al. Impact of a multidisciplinary care bundle for necrotizing skin and soft tissue infections: A retrospective cohort study. Ann. Intensive Care. 2019;9:123. DOI: 10.1186/s13613-019-0598-4

Urbina T, Canoui-Poitrine F, Hua C, Layese R, Alves A, Ouedraogo R, Bosc R, Sbidian E, Chosidow O., Dessap AM, et al. Long-term quality of life in necrotizing soft- tissue infection survivors: A monocentric prospective cohort study. Ann. Intensive Care. 2021;11:102. DOI: 10.1186/s13613-021-00891-9

Hua C, Sbidian E, Hemery F, Decousser JW, Bosc R, Amathieu R, Rahmouni A, Wolkenstein P, Valeyrie-Allanore L., Brun-Buisson C., et al. Prognostic Factors in Necrotizing Soft-Tissue Infections (NSTI): A Cohort Study. J. Am. Acad. Dermatol. 2015;73:1006–1012.e8. DOI: 10.1016/j.jaad.2015.08.054

Wong CH, Khin LW, Heng KS et al. The LRINEC (laboratory risk indicator for necrotizing fasciitis) score: A tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;1,535–1,541.

Carroll PR, Cattolica EV, Turzan CW, McAninch JW. Necrotizing soft-tissue infections of the perineum and genitalia. Etiology and early reconstruction. West J Med. 1986;144(2):174-8.

Aliev SA, Rafiev SF, Rafiev FS, Aliev ES. Furnier's disease in surgeon practice. Surdery J n.a. N.I. Pirogov. 2008;11:58–63.

Ephimenko NA, Privolnee VV. Furnier's gangrene. Clin Microbiol Antimicrob Chemother. 2008;10:25–34.

The LRINEC Score – An indicator for the Course and Prognosis of Necrotizing Fasciitis? Vanessa Hoesl, Sally Kempa, Lukas Prantl, Kathrin Oschsenbauer, Julian Hoesl, Andreas Kehrer, Talia Bosselmann J Clin Med. 2022;11(13): 3583. DOI: 10.3390/jcm11133583 PMCID: PMC9267597 PMID: 35806870

Hsiao CT, Chang CP, Huang TY, Chen YC, Fann WC. Prospective Validation of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) Score for Necrotizing Fasciitis of the Extremities. PLoS ONE. 2020;15:e02277 48. DOI: 10.1371/journal.pone.0227748

Bansal N, Garg N. Evaluation of Laboratory risk indicators (LRINEC Sore) for early diagnosis and prognosis in necrotizing fasciitis. Surg. Update Int. J. Surg. Orthop. 2020;6:181–188. DOI: 10.17511/ijoso.2020.i03.07

Bechar J., Sepehripour S., Hardwicke J., Filobbos G. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: A systematic review of the literature. Ann. R. Coll. Surg. Engl. 2017;99:341–346. DOI: 10.1308/rcsann.2017.0053

Harasawa T, Kawai-Kowase K, Tamura J, Nakamura M. Accurate and quick predictor of necrotizing soft tissue infection: Usefulness of the LRINEC score and NSTI assessment score. J. Infect. Chemother. 2020;26:331–334. DOI: 10.1016/j.jiac.2019.10.007

Laparoscopic Pelvic Anatomy—Series Two—The 8 Avascular Spaces. C. Nezhat, F. Nezhat, C. Nezhat, N. Lashay, M. Marziall. Center for Minimally Invasive Surgery, Palo Alto, CA; 2005.

Successful Laparoscopic Management of Retroperitoneal Necrotizing Fasciitis: A Case Report Monerh Bin Mosa, Ali Alyami, Saad Abumelha, and Ali Alzahrani; 2021.