Bayileyegn Nebiyou Simegnew, Tareke Amare Abera
Department of Surgery, Jimma University Medical Center, Jimma, Ethiopia.
Department of Biomedical Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Int J Surg Case Rep. 2022 May;94:106982. doi: 10.1016/j.ijscr.2022.106982. Epub 2022 Mar 30.
Fournier's gangrene is necrotizing fasciitis of the scrotum and perineal area. It is a polymicrobial infection of perianal origin characterized by rapid necrotizing spread along fascial planes to abdominal wall and flank area. The very rare nature of this illness in neonates makes it important to take a lesson in subsequent management of similar cases.
An eight days old male neonate come with compliant of high-grade intermittent fever, scrotal swelling, crying during urination and irritability of 3 days duration. Objectively he has temperature of 38.8 degree Celsius, pulse rate of 172 and blackish ulcerated scrotum with minimal puss discharge. Blood work showed leukocytosis and scrotal ultrasound ruled out other pathology.
Identifiable causes constitute about 80% of the cases. Culture from the puss in our case showed polymicrobial cause. Mortality is mainly due severe sepsis, coagulopathy and renal failure. Medical management include optimization of cardiorespiratory status with cautious resuscitation, respiratory support and inotropic support with severe cases. Prompt surgical debridement, incision and drainage help reduce ongoing infection and systemic toxicity.
The poor hygiene and immature immune response are the likely predisposing factors. Medical management with broad spectrum antibiotics and surgical debridement are cornerstones for good recovery.
福尼尔坏疽是阴囊和会阴区域的坏死性筋膜炎。它是一种源自肛周的多微生物感染，其特征是沿筋膜平面迅速发生坏死性扩散至腹壁和侧腹区域。这种疾病在新生儿中极为罕见，因此从后续类似病例的管理中吸取经验教训很重要。
一名8天大的男婴前来就诊，主诉有持续3天的高热间歇性发热、阴囊肿胀、排尿时哭闹和易激惹。客观检查发现他体温为38.8摄氏度，脉搏率为172，阴囊呈黑色溃疡，有少量脓性分泌物。血液检查显示白细胞增多，阴囊超声排除了其他病变。
可识别的病因约占病例的80%。我们病例中的脓液培养显示为多微生物病因。死亡率主要归因于严重脓毒症、凝血病和肾衰竭。药物治疗包括谨慎复苏以优化心肺状态、呼吸支持，严重病例给予血管活性药物支持。及时的手术清创、切开引流有助于减少持续感染和全身毒性。
卫生条件差和免疫反应不成熟可能是易感因素。使用广谱抗生素进行药物治疗和手术清创是良好康复的基石。
