Emergency diagnosis of Fournier's gangrene with bedside ultrasound

Fournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. Ultrasound has been previously described to aid in the diagnosis of Fournier's gangrene. In patients with low to moderate suspicion of Fournier gangrene, it may provide a rapid and reliable diagnosis and differentiate the pathological process from mimicking entities such as scrotal edema or cellulitis. We present 6 cases of Fournier's gangrene diagnosed in the ED at the patient's bedside using ultrasound. None of the patients had a history of diabetes, and 5 had sources of infection determined.     

Group C streptococcal sepsis complicating Fournier gangrene

Fournier gangrene is a life-threatening necrotizing fasciitis of the perineal-scrotal area that occurs in diabetic males. Patients typically present with systemic toxicity and significant inflammatory changes in the scrotum and perineum. Most cases of Fournier gangrene are polymicrobic and require urgent surgical debridement and broad-spectrum antibiotic therapy. We describe a case of Fournier gangrene in a young diabetic man that was associated with group C streptococcal bacteremia, an association previously unreported in the literature to our knowledge.     

Fournier Gangrene from a Thirty-Two-Centimeter Rectosigmoid Foreign Body

Background

Medical and surgical problems associated with rectal foreign bodies are rare. Although most rectal foreign bodies can be removed without subsequent sequelae, they pose significant risk of infection.

Objectives

We report a patient with a 32-cm rectosigmoid foreign body and subsequent development of Fournier gangrene despite successful removal of the foreign body.

Case Report

A 63-year-old Caucasian man with past medical history of diabetes mellitus and depression presented with a chief complaint of “something stuck in my intestine.” He admitted that he placed a foreign body in the rectum. Abdominal X-ray study and computed tomography of the abdomen/pelvis showed a conical-shaped 32-cm rectosigmoid foreign body. The foreign body was removed manually and follow-up colonoscopy was done. The patient's condition deteriorated in the first 2 days of hospital stay and he was diagnosed with Fournier gangrene. He required multiple surgeries and received broad-spectrum antibiotic coverage for mixed bacterial flora grown from deep tissue.

Conclusion

Rectal foreign bodies can cause Fournier gangrene. A close observation and follow-up is important after removal of rectal foreign bodies.     

Fournier gangrene

Fournier gangrene is a rapidly progressive necrotizing infection of the perineal and genital fascia, often polymicrobial. Severity is increased in older patients, diabetics and the immunocompromised. As in this case, the disease can have an indolent onset. Early recognition and aggressive treatment is important.     

Fournier's disease: Necrotizing gangrene of the male genitalia

Fournier's disease, a necrotizing subcutaneous infection involving the male genitalia, was first described by the French venereologist Jean Alfred Fournier in 1884. Its characteristic triad of abrupt onset in young, previously healthy males, rapid progression to gangrene, and absence of a discernable cause appear to have been altered, at least partially, by the advent of the antibiotic era. We present a case report, with discussion of the clinical and pathophysiological mechanisms involved in this rare and malignant infectious process.     

Sonographic diagnosis of Fournier’s gangrene: a rare surgical emergency

Early diagnosis of life-threatening Fournier’s gangrene, a rare surgical emergency, is essential. Detection of gas within the swollen scrotal skin by ultrasonography (US) is of great help in patients with equivocal physical examination findings.     

Fournier’s Gangrene

This article provides an overview of the diagnosis and treatment of Fournier’s gangrene, a necrotizing fasciitis of the perineal, genital, or perianal areas, which commonly affects men. The article will highlight the symptoms of the condition and the pertinent anatomy.     

Fournier坏疽临床分析12例

目的总结Fournier坏疽（FG）的临床特点、治疗原则及预后。 方法回顾性分析2005年1月至2016年12月间就诊于北京大学第一医院整形烧伤外科的FG患者。 结果共12例FG患者入组本研究,其中男性11例,女性1例,中位年龄54岁（21~78岁）。10例（83%,10/12）患者有明确病因,其中7例为肛周疾病,1例为阴囊皮肤擦伤,1例为腹膜后脓肿,1例为巴氏腺脓肿。6例（50%,6/12）患者合并糖尿病。除1号患者因呼吸、循环衰竭于入院第8天死亡而未予手术清创外,余11例患者均接受手术清创。中位手术次数7次（3~18次）,7例患者接受创面负压吸引治疗（NPWT）,中位治疗周期3次（3~7次）。伤口平均愈合时间为（52.7±17.7）d,6例创面植皮修复,5例直接缝合。6例（50%,6/12）患者存在多重细菌感染,6例（50%,6/12）患者为单一细菌感染,肠杆菌科、肠球菌属和溶血葡萄球菌为常见致病菌。中位随访时间32个月,11例患者均存活,且伤口愈合良好。 结论坏死性筋膜炎的实验室危险性指标评分是早期诊断与鉴别诊断的重要辅助工具。积极手术清创、经验性广谱抗生素和全身支持治疗是挽救患者生命的关键。创面负压吸引治疗是有效的治疗手段,游离植皮可作为阴茎、阴囊重建的推荐方案。     

多层螺旋CT在克罗恩病诊断中的临床应用价值

目的探讨多层螺旋CT在克罗恩病（Crohn＇s disease）诊断中的临床应用价值。方法回顾性分析经临床、肠镜或病理证实的49例肠道CD患者的多层螺旋CT征象,评价多层螺旋CT检查在诊断Crohn’s disease中的价值。结果横断面三期扫描及多层面重建观察,小肠型28例,回结肠型14例,结肠型7例。49例患者肠壁均节段性增厚,增强后均明显强化,强化方式主要是环形分层强化,病变周围系膜水肿40例,肠系膜周围淋巴结肿大46例,假憩室5例。最大密度投影（maximum intensity projection）肠系膜血管增多、增粗38例。并发肠瘘5例、不全性肠梗阻2例。结论多层螺旋cT检查在肠道Crohn＇s disease的定位、分型、分期、病变范围显示的诊断中具有重要意义,对肠道克罗恩病治疗后随访有重要的价值。     

Moderate dietary temperance effectively prevents relapse of Crohn disease: a prospective study of patients in remission.

The authors examined the influence of diet (dietary fat intake and dietary temperance) on relapse of patients with Crohn disease. A 1-year prospective study of 76 patients with Crohn disease was conducted. The criterion for eligibility was a Crohn Disease Activity Index score of 150 or lower for at least 1 month. The primary end point was defined as the relapse-free interval from the baseline until the first relapse. Fat intake was assessed using a validated diet history questionnaire. The degree of dietary temperance was assessed using a single-item nominal scale. The Cox proportional hazards model was used to evaluate the influence of diet. Crohn disease relapse was seen in 25 patients (33%), and 47 patients (62%) remained in continuous remission. A decreased ratio of n-6 polyunsaturated fatty acid (PUFA) to n-3PUFA (odds ratio = .38; p = .005) was associated with a poor prognosis. Dietary temperance also was significantly associated with prognosis (p = .014). More moderate dietary temperance decreased the risk of relapse (odds ratio = .22; p = .006). Effective prevention of relapse for Crohn disease patients might be achieved through moderate dietary temperance, particularly when the disease condition is unstable.     

克罗恩病患者血清总25羟维生素D及细胞因子水平表达与疾病活动指数的相关性研究

目的探讨克罗恩病患者血清总25羟基维生素D、细胞因子白介素6(IL-6）、白介素8(IL-8）和肿瘤坏死因子α（TNF-α）在克罗恩病不同时期的表达水平以及其与疾病活动指数（CDAI）的相关性。方法选取2018年1月～2020年12月在北京大学深圳医院就诊的克罗恩病患者共100例纳入研究。收集患者的空腹静脉血,检测总25羟基维生素D,IL-6,IL-8和TNF-α水平;采用CDAI评估患者疾病活动情况,并根据CDAI评分将患者分为四组,缓解期21例,轻度活动期32例,中度活动期29例和重度活动期18例。比较CDAI评分不同分期患者的血清总25-羟基维生素D,IL-6,IL-8和TNF-α的表达水平。并进一步分析比较患者CDAI与血清总25-羟基维生素D水平及细胞因子IL-6,IL-8及TNF-α表达水平之间的相关性。结果四组患者血清总25-羟基维生素D及细胞因子IL-6,IL-8和TNF-α的差异均存在统计学意义（F=34.281～128.53,均P<0.05）。缓解期患者血清总25-羟基维生素D (23.49±3.46μg/L),IL-8(86.39±11.23ng/L）和TN...     

克罗恩病患者疾病不确定感及影响因素分析

目的 了解克罗恩病患者疾病不确定感现状,并探讨其影响因素.方法 采用一般资料调查表、疾病不确定感量表、医学应对问卷对符合纳入标准的144例克罗恩病住院患者进行问卷调查,采用多重线性回归分析克罗恩病患者疾病不确定感的影响因素.结果 克罗恩病患者疾病不确定感总分为(88.27±6.52)分;手术次数、疾病活动度以及医学应对方式(面对、回避、屈服)是患者疾病不确定感的影响因素(P<0.05).结论 克罗恩病患者的疾病不确定感水平偏高,医护人员需关注手术次数多、病情较复杂且不能正确面对疾病的患者,给予患者更多的信息及心理支持,鼓励患者采取积极的应对方式,以降低疾病不确定感对患者的影响,从而改善患者的身心健康及生存质量.     

克罗恩病患者肠内营养系统管理的护理实践

目的 探讨系统管理在克罗恩病患者肠内营养护理中的应用效果。方法 采用自身前后对照设计。便利抽取北京市某三级甲等医院消化内科45例住院克罗恩病患者,实施肠内营养系统管理,评估患者接受肠内营养治疗基线、干预后1个月、3个月、6个月营养状况及不良反应等。采用重复测量资料分析方法分析不同时间点评估指标差异。结果 经过6个月干预,营养状况相关指标（体重、营养风险筛查评分、总蛋白、白蛋白、血红蛋白）均有明显升高,炎性指标（血沉、C反应蛋白）均有明显降低（P<0.05）,肠道症状及不良反应发生率逐渐降低。结论 克罗恩病患者肠内营养系统管理能够有效改善患者的营养状况,提高患者依从性,改善营养护理工作质量。     

MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients?

Purpose

Though perianal fistulas are commonly seen in patients with Crohn’s disease, they can also be seen in patients without inflammatory bowel disease. The purpose of this study was to evaluate MR imaging differences of perianal fistulas in patients with and without Crohn’s disease.

Methods

Our retrospective search from January 2012 to December 2015 of the Radiology database for perianal fistula yielded 207 patients. Only patients with dedicated MR fistula protocol studies were included, whereas patients with previous anal surgery or anastomosis, anorectal tumors, and equivocal findings that could not be definitely assessed as a fistula were excluded. The following features were assessed: anatomic type of fistula (Parks Classification), luminal origin (hour clock position), anal verge distance, signs of acute inflammation, circumference of anus involved by inflammation, presence of rectal inflammation. and abscess.

Results

One hundred and twenty six of 207 patients met inclusion criteria. Of these, 96 (76.2%) had Crohn’s disease and 30 (23.8%) did not. The most common fistulas identified were transphincteric (38.5% of Crohn’s and 50% of non-Crohn’s) and intersphincteric (33.3% of Crohn’s and 35.4% of non-Crohn’s). An abscess was associated in 41 cases, 32 (33.3%) in the Crohn’s group and 9 (30.0%) in the non-Crohn’s group. Rectal inflammation was present in 29 patients with Crohn’s disease (29.2%) and in 2 without Crohn’s (6.7%). This finding was statistically significant (p = 0.0009).

Conclusions

Our study demonstrates that while both groups can have similar MR imaging features, accompanying rectal inflammation was more commonly seen in Crohn’s disease.

     

Necrotizing fasciitis and gangrene associated with topical herbs in an infant

A 4-mo-old Chinese infant developed necrotizing fasciitis and gangrene from a small skin infection on his buttock that was treated with topical herbs. Sequential cultures revealed a number of organisms:Enterococcus species, sensitive to ampicillin, were isolated throughout the course, and coagulasenegative staphylococci replaced gram-negative rods during the later phase of the illness. The infant required prolonged intravenous antibiotic treatment and underwent multiple surgical procedures for debridement and reconstruction. This report serves to alert the public of the importance of avoiding application of unknown topical herbs in children with skin disease. A seemingly small wound, if inappropriately treated, may result in extensive tissue destruction and require extensive surgery.     

Coexistence de tumeur carcino?de et maladie de Crohn iléale: une nouvelle observation !

The association of small bowel cancer and Crohn’s disease is a known fact. This association is especially described for adenocarcinoma. However, the coexistence of a malignant carcinoid tumor and ileal Crohn’s disease was reported eleven times in the literature. We report a new observation of ileal carcinoid tumor associated with Crohn’s disease.     

血浆早老蛋白-1对溃疡性结肠炎及克罗恩病的诊断价值

【目的】研究炎症性肠病患者血浆早老蛋白-1（Presenilin-1）的表达和对溃疡性结肠炎及克罗恩病的鉴别诊断价值。【方法】应用酶联免疫吸附试验（ELISA）分析克罗恩病患者、溃疡性结肠炎患者和正常对照者血浆中Presenilin1的表达水平。通过受试者工作特征（receiver-operatingcharacteristic,ROC）曲线观察血浆Presenilin-1水平对溃疡性结肠炎患者和克罗恩病患者的鉴别诊断价值。【结果】溃疡性结肠炎患者血浆Presenilin-1水平显著高于正常对照者（Pd0．01）和克罗恩病患者（P=0．0053）,同时血浆对Presenilin-1水平对克罗恩病患者和溃疡性结肠炎患者具有显著的鉴别价值（AUC=0．7657,P〈0．01）,但是溃疡性结肠炎患者血浆Presenilin-1与内镜疾病活动性无显著相关性（Spearman r=0．1224,P=0．4022）。【结论】溃疡性结肠炎患者血浆Presenilin-1表达水平增高,可能对鉴别诊断克罗恩病有一定价值。     

小肠CT成像对克罗恩病活动性的评估价值

目的 评估小肠CT成像(CTE)与克罗恩病临床症状之间的相关性.方法 收集2016年9月至2019年9月60例克罗恩病患者CTE数据,并对患者的临床参数进行回顾性分析.其中CTE参数包括:肠壁增厚和强化,肠系膜脂肪增生,血管增多和并发症(瘘管、狭窄、脓肿).克罗恩病疾病活动性评估采用克罗恩病活动指数(CDAI)和临床生...     

Cold autoimmune haemolytic anaemia secondary to Epstein Barr virus infection presenting with peripheral gangrene; case report

ABSTRACT: A sixty year old male presented with dark urine, symptomatic anaemia and peripheral gangrene following cold exposure. Investigations revealed that he had haemolysis and serological evidence of recent Epstein Barr virus infection. Although acrocyanosis is commonly associated with cold agglutinin disease, gangrene is a rare complication. Management of secondary cold agglutinin disease is mainly supportive.     

A comprehensive guide to patient-focused management strategies for Crohn disease.

In Crohn disease, a vigorous inflammatory cascade is caused by the overactivation of helper T-cells in the gastrointestinal system. The results of this inflammation manifest themselves as the symptoms of Crohn disease. This article describes the pathophysiology of Crohn disease as well as multiple pharmacologic and nonpharmacologic interventions that may assist patients with Crohn disease in preventing exacerbations and maintaining longer remissions.