Abstract

PINHO, Sara Lisa; HENRIQUES, Rafael  and  GUERREIRO, Natália. Fournier gangrene: a urologic emergency that we must recognize - a case report. Rev Port Med Geral Fam [online]. 2020, vol.36, n.4, pp.369-373. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v36i4.12628.

Introduction: It is common for the family physician (FP) to approach cases in their initial phase, with nonspecific semiology. Part of his functions is to properly manage the articulation with the secondary health care, especially emergencies. Fournier’s gangrene (FG) is a rare but potentially fatal necrotizing infection, whose timely diagnosis and treatment may save the patient’s life. Case description: A 66-year-old male reached his FP due to anal pain and fever for two days. From his medical history, we highlight type two diabetes, hypertension, and dyslipidaemia. He presented with no fever or acute distress, and his rectal exam only revealed non-thrombosed haemorrhoid. He returned on the next day to an emergency appointment due to maintaining his previous symptoms plus a worse general status and intense testicular pain with an eight hours evolution. Physical exam revealed, besides a bad clinical impression, oedema, and flushing of the scrotal region. He was immediately directed to the hospital’s emergency room, where it was performed a scrotal ultrasound that revealed left orchitis. The patient started empiric intravenous antibiotics and was admitted to the urology department. On the third day of hospitalization, he developed scrotal necrosis with perineal extension and was submitted to surgical debridement of the necrotized tissues, with the need for a derivative colostomy and posterior intervention by plastic surgery for reconstruction of the scrotal and perianal regions. Currently, he shows a favourable evolution. Comment: FG is a serious necrotizing urogenital infection. On this patient, haemorrhoid as a site of entry and diabetes as a predisposing factor might have contributed to the development of the disease. It emphasizes the importance of proper articulation between primary and secondary health care because of early diagnosis and treatment in this case allowed to beat the odds of the high mortality associated with this disease.

Keywords : Primary health care; Diabetes; Fournier gangrene; Urologic diseases.

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