Fournier's gangrene associated with Crohn's disease which progressed to widespread lower extremity gas gangrene

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  • Ohtsuka Yasuhiro
    Department of General and Emergency Medicine, Funabashi Central Hospital of Japan Community Health Care Organization (JCHO)

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  • クローン病に併発し広範な下肢ガス壊疽に進展したフルニエ壊疽の1例

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A 43-year-old man receiving combination therapies, including steroid therapy, for Crohn's disease, was admitted to our department with pain in the left lower extremity. Physical examination revealed periproctal abscess, and the swelling was accompanied by redness and snow grasping sense at the perineum, left buttock, thigh, and lower leg. Blood examinations revealed the signs of an inflammatory reaction and acute kidney injury, while CT scan revealed extensive subcutaneous gas along the fascial planes extending from the perineum to the left lower leg. Under the diagnosis of Fournier's gangrene which had progressed to widespread lower extremity gas gangrene, emergency incisional open drainage and debridement were performed. The diagnosis of non-clostridial gas gangrene (mixed infections) was made based on the results of microbial examination of the drained pus. After the operation, daily wound irrigation, total parenteral nutrition, transanal ileus tube insertion for fecal drainage, administrations of meropenem and immunoglobulin, and steroid cover were performed. Although re-incision of the abscess at the left thigh was required on the 8th hospital day, the following clinical course was uneventful. After auto skin grafting for the incisional wounds, the patient was discharged on the 247th hospital day.

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