A Rare Fournier's Gangrene: Caused by Metastatic Adenocarcinoma Misdiagnosed as Perianal Abscess

佛尼爾氏壞疽症之罕見致病因：肇因於轉移腺癌併發肛門周圍膿瘍－病例報告

黃挺達(Ting-Da Huang) ； 楊菘宇(Sung-Yu Young) ； 鄭舉緒(Chu-Hsu Jeng) ； 林煌基(Hwang-Chi Lin) ； 蔡裕銓(Yuh-Chyuang Tsai)

《中華民國整形外科醫學會雜誌》 15卷1期 (2006/03) Pp. 43-50

https://doi.org/10.7096/JPSA.200603.0043

摘要

時至今日，儘管對於佛尼爾氏壞疽症的病理生理學較早期有進一步的瞭解，此症的致死率依然偏高。佛尼爾氏壞疽症的治療除了早期正確診斷、緊急擴創及廣效性抗生素的使用外，確認並去除其致病根源也同樣值得重視。當基本理學檢查未能發現此病症患者之感染根源時，應懷疑是否存在有腹腔內的感染源甚至是潛在的惡性腫瘤所造成。而大腸直腸惡性腫瘤雖少見於此症患者，但確實可能造成佛尼爾氏壞疽症的發生。若能在病況進入壞疽前期之前及時發現惡性腫瘤，或可改變病程。在此我們提出一病例報告。

並列摘要

Despite better understanding of the pathophysiology of Fournier's gangrene, mortality rates remain high; and improved antimicrobial therapy, medical care and various adjunctive treatment do not seem to give a reliable survival benefit. It seems that not only accurate early diagnosis but also identification of the origin of the disease are worthy to be advocated. In cases when an origin of the infection cannot be determined by the clinical examination, an intraabdominal source even occult malignancy should be suspected. Though rarely reported, Fournier's gangrene could be caused by the complications of colorectal carcinomas. We report a case of Fournier's gangrene resulting from metastatic adenocarcinoma of lower GI origin misdiagnosed as perianal abscess.

並列關鍵字

Fournier's gangrene ； complications of colorectal carcinomas ； metastatic adenocarcinoma of lower GI origin