尿管置放之尿道損傷導致會陰部壞死性筋膜炎之案例報告

李虹霈¹、阮雍順¹

高雄醫學大學附設醫院 泌尿部 ¹

Case report: Founier’s gangrene secondary to traumatic urethral catheterization

Hung-Pei Li¹、 Yung-Shun Juan¹

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Abstract

  A 65-year-old man with underlying disease of Hemorrhagic cystitis, End stage renal disease, Type 2 diabetes mellitus, coronary artery disease, hypertension and dyslipidemia. Due to acute urine retention, he went to the emergency department and Foley catheter insertion was done. Scrotum swelling and fever was noted after Foley catheter insertion. Laboratory data showed severe leukocytosis(31560/uL) with left shift and c-reactive protein elevation(233.4mg/L). Abdominal Computed Tomography revealed Foley catheter malposition and gas formation in the perineum. Under the impression of urethral catheter malposition and Fournier’s gangrene, Foley re-position under cystoscopy and perineal debridement were done. During the secondary debridement, urethra rupture with Foley exposure was noted. Cystostomy was performed for urine drainage bypass.  At the fifth time of debridement, primary closure of the debridement wound was done. Owing to the long segment rupture of the urethra, we did not repair the urethra and kept the cystostomy.

  We share the rare case of the iatrogenic urethral trauma causing Fournier’s gangrene to emphasize the importance of accurate urethral catheterization. After the numerous debridement, the patient recovered uneventfully.