Fournier's Gangrene: A Rare Differential Diagnosis of Acute Abdomen

Fournier's壞疽：急性腹痛罕見之鑑別診斷

藍國徵(Kuo-Cheng Lan) ； 張立偉(Li-Way Chang)

《Journal of Medical Sciences》 19卷3期 (1998/12) Pp. 172-177

摘要

一位63歲有糖尿病史的男性，因右下腹和會陰部疼痛一天之久到急診求治。理學檢查發現有右下腹壓痛，並且可觸摸到皮下氣腫和會陰皮膚呈現紅腫變化。當時根據腹部X光影像和骨盆電腦斷層掃瞄，高度懷疑Fournier's壞疽合併後腹膜腔侵犯。病患立即接受外科清創手術，發現在腹壁、右大腿、陰囊、會陰部和後腹膜腔，有嚴重壞死性肌筋膜炎情形。此病例顯示出Fournier's壞疽可以急性腹痛來表現，對於具有高危險因子的病患，同時有會陰部不適的主訴時，應高度懷疑此一疾病。

關鍵字

腹痛 ； 壞疽 ； 會陰

並列摘要

A 63-year-old Chinese man was admitted to the emergency department with severe pain over the right lower quadrant (RLQ) of abdomen and perineum of 1-day's duration. He had a significant history of diabetes mellitus. Abdominal palpation revealed tenderness with subcutaneous crepitus over the RLQ of abdominal wall. Perineal skin showed erythematous swelling. Fournier's gangrene with retroperitoneal invasion was suspected from the pattern of KUB, and computed tomography of the pelvis demonstrated the extent of infectious process. Operative findings during surgical debridement showed necrotizing myofasciitis over the abdominal wall, right thigh scrotum and perineum with retroperitoneal invasion. The case presented here should increase physicians' awareness of the condition of Fournier' gangrene which may present with acute abdomen and the physician must have a high index of suspicion in a high risk patient with vague perineal complaints.

並列關鍵字

abdominal pain ； gangrene ； perineum