Nakamura H, Katizawa K, Inada Y, Kato N, Mukai M, Akashi M, Sugisaki T
Department of Internal Medicine, Kanto Rosai Hospital, Kanagawa, Japan.
Clin Nephrol. 2005 Apr;63(4):317-20. doi: 10.5414/cnp63317.
We present a rare case of perineal-onset Fournier's gangrene in a patient undergoing hemodialysis. A 51-year-old Japanese man manifested an acute-onset perineal pain with perirectal abscess; subsequently, the pain extended to the abdomen, chest, and loin despite quick treatment. His consciousness deteriorated to delirium and he died of septic shock on the third day of admission. Computed tomography (CT) revealed soft-tissue air along the right rectal wall, moreover, the infection extended to the anterior wall of the bladder and the right peripsoas muscle. On the basis of the clinical course and CT findings, the patient was diagnosed as having the complications of Fournier's gangrene, however, no scrotal lesions were detected. Fournier's gangrene is considered to be easily diagnosed on the basis of skin lesions, such as scrotal erythema and swelling. However, in the early stage, the diagnosis of Fournier's gangrene is difficult in a patient with perineal pain before the detection of skin lesions. In conclusion, definitely the key to improving the prognosis of this fulminant infection is the prompt recognition of the pathological process. Therefore, Fournier's gangrene should always be considered when patients undergoing hemodialysis manifest perirectal disorders, even when no scrotal lesions are detected, because there is the possibility of intra-abdominal and intra-retroperitoneal infections resulting in septic shock.
我们报告一例正在接受血液透析的患者发生会阴起病的福尼尔坏疽的罕见病例。一名51岁的日本男性表现为急性发作的会阴疼痛伴直肠周围脓肿；尽管接受了快速治疗，但疼痛仍蔓延至腹部、胸部和腰部。他的意识恶化为谵妄，并在入院第三天死于感染性休克。计算机断层扫描（CT）显示沿右直肠壁有软组织积气，此外，感染蔓延至膀胱前壁和右腰大肌。根据临床病程和CT检查结果，该患者被诊断为福尼尔坏疽并发症，然而，未发现阴囊病变。福尼尔坏疽通常被认为根据皮肤病变如阴囊红斑和肿胀很容易诊断。然而，在早期，在皮肤病变出现之前，对于有会阴疼痛的患者，福尼尔坏疽的诊断很困难。总之，改善这种暴发性感染预后的关键肯定是对病理过程的及时识别。因此，当接受血液透析的患者出现直肠周围疾病时，即使未发现阴囊病变，也应始终考虑福尼尔坏疽，因为存在腹腔内和腹膜后感染导致感染性休克的可能性。
