Rectal cancer and Fournier's gangrene- current knowledge and therapeutic options

作     者：Tomislav Bruketa Matea Majerovic Goran Augustin 

作者机构：Department of SurgeryUniversity Hospital Center Zagreb Department of Internal MedicineUniversity Hospital Center Zagreb Department of SurgeryDivision of Gastroin- testinal SurgeryUniversity Hospital Center Zagreb School of MedicineUniversity of Zagreb 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2015年第21卷第30期

页      面：9002-9020页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 100214[医学-肿瘤学] 10[医学] 

主　　题：Fournier's gangrene Necrotizing fasciitis Proctological examination Necrotizing soft tissueinfections Oncological treatment Rectal cancer Surgical treatment Reconstructive surgery 

摘      要：Fournier s gangrene(FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal,perianal and perineal region. The incidence has increased dramatically,while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination,when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First,the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%,while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second,oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal,scrotal and lower abdominal wall defects.