内容紹介
A Case of Fournier's Gangrene Due to Perforation of Lower Rectal Cancer during Chemotherapy
Summary
Fournier's gangrene is a rapidly progressing bacterial infection, involving the subcutaneous and deep fascia. Although intestinal perforation after treatment with bevacizumab is well known, Fournier's gangrene rarely occurs during chemotherapy. A 73-year-old man with unresectable rectal cancer during chemotherapy involving the mFOLFOX6 plus bevacizumab regimen had a consciousness disorder and was admitted to our hospital on emergency. Computed tomography scans indicated a necrotizing soft tissue infection with large amounts of pneumoderma throughout the perineum. He was diagnosed as having Fournier's gangrene via perforation of rectal cancer, and urgent operation was performed. After debridement of the skin and soft tissue around the perineum, loop sigmoidostomy was performed. A nice granulated tissue bed over the perineum was formed via daily lavage with sarin. Although the patient was taken back to the operation theater for ileostomy, he could resume chemotherapy involving mFOLFOX6 without bevacizumab 50 days after the initial operation. It is necessary to pay attention to Fournier's gangrene via perforation during chemotherapy with bevacizumab in patients with lower rectal cancer.
要旨
フルニエ症候群は,急激に進行する壊死性筋膜炎である。bevacizumabを伴う化学療法では消化管穿孔の合併症がよく知られているが,治療中にフルニエ症候群を発症した報告はまれである。症例は73歳,男性。切除不能進行直腸癌に対してmFOLFOX6+bevacizumab療法を行っていたところ,意識障害が出現し,救急搬送され来院した。造影CT検査で会陰全体に皮下気種と膿瘍形成を認めた。直腸癌穿孔に伴うフルニエ症候群と診断し,緊急手術を施行した。会陰周囲の広範な開窓,デブリートマンおよびS状結腸ストーマ造設術を施行した。局所の洗浄処置にて会陰の肉芽形成は良好となった。回腸ストーマ再造設を要したが,術後50日目にmFOLFOX6単独療法で治療を再開した。下部直腸癌に対するbevacizumabを伴う化学療法中は,穿孔によるフルニエ症候群に注意を要する。
目次
Summary
Fournier's gangrene is a rapidly progressing bacterial infection, involving the subcutaneous and deep fascia. Although intestinal perforation after treatment with bevacizumab is well known, Fournier's gangrene rarely occurs during chemotherapy. A 73-year-old man with unresectable rectal cancer during chemotherapy involving the mFOLFOX6 plus bevacizumab regimen had a consciousness disorder and was admitted to our hospital on emergency. Computed tomography scans indicated a necrotizing soft tissue infection with large amounts of pneumoderma throughout the perineum. He was diagnosed as having Fournier's gangrene via perforation of rectal cancer, and urgent operation was performed. After debridement of the skin and soft tissue around the perineum, loop sigmoidostomy was performed. A nice granulated tissue bed over the perineum was formed via daily lavage with sarin. Although the patient was taken back to the operation theater for ileostomy, he could resume chemotherapy involving mFOLFOX6 without bevacizumab 50 days after the initial operation. It is necessary to pay attention to Fournier's gangrene via perforation during chemotherapy with bevacizumab in patients with lower rectal cancer.
要旨
フルニエ症候群は,急激に進行する壊死性筋膜炎である。bevacizumabを伴う化学療法では消化管穿孔の合併症がよく知られているが,治療中にフルニエ症候群を発症した報告はまれである。症例は73歳,男性。切除不能進行直腸癌に対してmFOLFOX6+bevacizumab療法を行っていたところ,意識障害が出現し,救急搬送され来院した。造影CT検査で会陰全体に皮下気種と膿瘍形成を認めた。直腸癌穿孔に伴うフルニエ症候群と診断し,緊急手術を施行した。会陰周囲の広範な開窓,デブリートマンおよびS状結腸ストーマ造設術を施行した。局所の洗浄処置にて会陰の肉芽形成は良好となった。回腸ストーマ再造設を要したが,術後50日目にmFOLFOX6単独療法で治療を再開した。下部直腸癌に対するbevacizumabを伴う化学療法中は,穿孔によるフルニエ症候群に注意を要する。