Fukuhisa Haruhi, Baba Kenji, Kita Yoshiaki, Tanabe Hiroshi, Ijichi Tetsuya, Mori Shinichiro, Natsugoe Shoji
Dept. of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences Kagoshima University.
Gan To Kagaku Ryoho. 2017 Oct;44(10):935-937.
Fournier's gangrene is a rapidly progressing bacterial infection, involving the subcutaneous and deep fascia. Although intestinal perforation after treatment with bevacizumab is well known, Fournier's gangrene rarely occurs during chemotherapy. A 73-year-old man with unresectable rectal cancer during chemotherapy involving the mFOLFOX6 plus bevacizumab regimen had a consciousness disorder and was admitted to our hospital on emergency. Computed tomography scans indicated a necrotizing soft tissue infection with large amounts of pneumoderma throughout the perineum. He was diagnosed as having Fournier's gangrene via perforation of rectal cancer, and urgent operation was performed. After debridement of the skin and soft tissue around the perineum, loop sigmoidostomy was performed. A nice granulated tissue bed over the perineum was formed via daily lavage with sarin. Although the patient was taken back to the operation theater for ileostomy, he could resume chemotherapy involving mFOLFOX6 without bevacizumab 50 days after the initial operation. It is necessary to pay attention to Fournier's gangrene via perforation during chemotherapy with bevacizumab in patients with lower rectal cancer.
福尼尔坏疽是一种进展迅速的细菌感染，累及皮下组织和深筋膜。虽然贝伐单抗治疗后肠穿孔已广为人知，但福尼尔坏疽在化疗期间很少发生。一名73岁患有不可切除直肠癌的男性在接受包含mFOLFOX6加贝伐单抗方案的化疗期间出现意识障碍，紧急入院。计算机断层扫描显示整个会阴区有大量皮下积气的坏死性软组织感染。他被诊断为直肠癌穿孔导致的福尼尔坏疽，并接受了紧急手术。在对会阴周围的皮肤和软组织进行清创后，实施了乙状结肠袢造口术。通过每日用沙林冲洗，会阴处形成了良好的肉芽组织床。尽管患者后来因回肠造口术再次进入手术室，但在初次手术后50天，他能够恢复不含贝伐单抗的mFOLFOX6化疗。对于低位直肠癌患者，在使用贝伐单抗化疗期间有必要注意因穿孔导致的福尼尔坏疽。
