Süt çocuðunda anorektal cerrahi sonrasý geliþen Fournier’s gangreni: Ýki olgu sunumu

Nekrotizan fasiit, deri, subkutan dokular ve fasyalarýn ilerleyici nekrozu ile karakterize, yaþamý tehdit eden bir yumuþak doku enfeksiyonudur. Fournier gangreni (FG), perianal ve genital bölgenin tutulduðu nekrotizan fasitin ciddi ve agresif bir þeklidir. Burada anorektal cerrahi sonrasý çevre dokuda yaygýn nekroz geliþen ve septik þoka neden olan iki FG olgusu sunulmuþtur. Olgu 1: Öyküsünde anal darlýk ve duplikasyon yapýlan altý aylýk kýz hasta ateþ, uykuya meyil ve emmeme yakýnmalarý ile baþvurdu. Fizik muayenesinde anal bölgede ekimoz olan hasta septik þok bulgularýyla Yoðun Bakým Ünitesi’ne (YBÜ) alýndý. Uygun antibiyotik tedavisi baþlanan hastanýn on iki saat içerisinde lezyonun nekrotik hale gelmesi üzerine acil cerrahi debridman uygulandý. Kan ve doku kültürleri negatif saptanan hastada baþvurudan itibaren iki ay içerisinde tam iyileþme saptandý. Olgu 2: Dokuz aylýk erkek hasta fistülotomiden sekiz saat sonra dirençli nöbet ve septik þok bulgularý ile YBÜ’ye yatýrýldý. Fizik muayenesinde skrotal, gluteal ve perianal bölgede ödem ve ekimoz gözlendi. Septik þoktaki hastaya temel yaþam desteði verildikten sonra geniþ spektrumlu antibiyotik tedavisi baþlandý ve perianal debridman yapýlarak kolostomi açýldý. Tamamen düzelme hiperbarik oksijen tedavisi sonrasý baþvurunun üçüncü ayýnda saðlandý. Anoraktal cerrahi uygulanan her hasta FG açýsýndan dikkatle izlenmelidir. Erken debridman, uygun antibiyotik tedavisi ve hiperbarik oksijen tedavisi hayat kurtarýcý olabilir.

Fournier’s gangrene after anorectal surgery in infant: Two case reports

Necrotizing fasciitis is a life-threatening soft tissue infection characterized by progressive necrosis of the skin, subcutaneous tissues and fascia. Fournier’s gangrene (FG) is a serious and aggressive form of infective necrotizing fasciitis involving perineal region and genitalia. Presently described are 2 pediatric cases of FG with widespread necrosis of surrounding tissue following anorectal surgery, causing severe septic shock. Case 1: Six-month-old female patient with anal stenosis and duplication presented at emergency clinic with fever, somnolence, irritability, and feeding difficulty. Physical examination upon admission to Intensive Care Unit (ICU) with septic shock determined she had ecchymosis in anal region. At 12fth hour after admission, lesion had become necrotic and patient was started on broad-spectrum antibiotics after surgical debridement. Cultures were negative and patient had complete recovery 2 months after admission.
Case 2: Nine-month-old male patient was admitted to ICU for convulsions and sepsis eight hours after fistulectomy. Scrotal, gluteal, and perianal edema and ecchymosis were observed on physical examination. Perianal debridement and colostomy were performed, and patient was given broad-spectrum antibiotics after basic life support strategies for septic shock. Complete recovery was achieved after hyperbaric oxygen treatment for perianal lesion and patient was discharged from the hospital in third month after admission.
After anorectal surgery, every patient should be observed carefully for FG. Early debridement, proper antibiotics, and hyperbaric oxygen treatment can be life-saving.