Septic Shock in a Patient with the Fourniér Gangrene with Fatal Outcome

Czech version

Authors: P. Zonča; T. Mrázek; A. Matušek; Hájek M.. Štiglerová S. ^{1 1}; A. Jurytko; C. Kučera ¹; M. Nieslanik ²
Authors‘ workplace: Chirurgické a traumatologické oddělení, MN Ostrava, primář: MUDr. T. Mrázek, Ph. D. ; Oddělení ARO, pracoviště Hyperbarické komory, MN Ostrava, primář: MUDr. C. Kučera ¹; Oddělení patologie, MN Ostrava, emeritní primář: MUDr. M. Nieslanik ²
Published in: Rozhl. Chir., 2009, roč. 88, č. 7, s. 398-402.
Category: Monothematic special - Original

Overview

Aim:
The authors present a case of a patient with developed Fourniér gangrene and septic shock. Fourniér gangrene belongs to the group of local non-specific infection of soft tissues (NSTI). Its incidence is relatively low, but the infection is extraordinary aggressive with a possible lethal end.

Material and Method:
39 years old patient with 4 days history of Fournier gangrene’s development was admitted in irreversible septic shock. The initial APACHE II score was 36. The delay in treatment was an important factor in the further course of illness with lethal end.

Results:
Above the mentioned 39 years old patient died because of septic shock. The hemorrhagic cystitis was the original source of infection with further development of Fourniér gangrene according to the pathological record.

Conclusion:
We often come across all different kinds of stages of sepsis from the MODS to the septic shock for patients with Fourniér gangrene. Causal treatment should be started early. The local surgical excision and wide broad antibiotic administrations are basic treatments in the context of other treatment modalities according to the current patient’s needs. The adjuvant hyperbaric oxygen treatment takes place in patients with Fourniér gangrene as well and is beneficial. The following factor even worsens the illness prognosis: delay in diagnostic, higher age, anorectal origin of infection, the amount of organ with dysfunction or failure, diabetes mellitus and significant immunodeficiency.

Key words:
Fourniére – gangrene – focal – NSTI – sepsis

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