Acute paraproctitis, Fournier's phlegmon: a clinical case. Radical treatment with the plasty of the wound of the perineum and scrotum

Abstract

Background: The article presents the stages and results of treating a patient with a life-threatening condition caused by acute paraproctitis complicated by necrotizing fasciitis of the perineum and scrotum (Fournier's gangrene). The patient underwent a radical surgical treatment with the removal of the affected tissues, and, in the delayed period, a plastic surgery of the perineum and scrotum with a pedicled flap. Clinical case description: Patient Sh., 62 years old, was hospitalized at the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia on an emergency basis with the following diagnosis: acute horseshoe-shaped posterior paraproctitis; non-clostridial phlegmon of the perineum and scrotum; sepsis. The patient was operated on urgently: a total necrectomy was performed with a wide excision of the affected tissues, excision of the anterior fistula, and a leak along the left inguinal cord into the abdominal cavity was identified and drained. The patient's condition in a few hours after the operation was characterized by pronounced positive dynamics, the effects of intoxication were stopped. 7 hours after the operation, the patient was transferred from the ICU to the department of coloproctology. A repeated surgical treatment with the revision of wounds was not required. 16 weeks after the first operation, a planned operation was performed with an excision of the fistula of the rectum and plasty of the perineum and scrotum with a rotary flap. The wounds healed by first intention. The patient recovered with all the pelvic functions completely restored. Conclusion: This clinical example can be used as a guide for the step-by-step treatment in this category of patients.