広範囲に進展したFournier's gangreneの1例

Abstract

52歳男.陰嚢部腫脹, 掻痒感が出現し, 掻破とステロイドの軟膏塗布で悪化し, 陰嚢全体の腫脹となり, 疼痛が急速に進展し, 全身状態が悪化した.腹部単純X線で陰嚢内に一致して広範囲のガス像を認めた.病歴と検査所見から, Fournier壊疽と診断し, 腰椎麻酔下に, 陰嚢部から両側鼠径部に至る壊死組織のデブリドマンを施行した.筋膜は陰嚢部から両側鼠径部に沿って壊死していた.ドレーン留置後の経過は良好で, 16日後に抜去, 第40病日に右大腿部皮膚の網状植皮による分層植皮術を施行した

A 52-year-old man was admitted to our hospital complaining of high grade fever and painful swelling of the scrotum. Although debridement of the scrotum and inguinal region was immediately carried out, the inflammation extended to the right abdominal region 2 days later. We tunneled the newly infected areas and placed Penrose drains through the tunnels, so that complete drainage was achieved with minimal tissue loss. The infection was controlled by frequent irrigation of the wound and antibiotic administration. Forty days after the admission the defect of the skin was reconstructed by using a meshed skin graft, and the patient was discharged on the 68th hospital day. We concluded that limited debridement with placement of through-and-through drains might have produced a good result with minimal tissue loss.