尿道置入異物後造成尿道破裂與會陰部壞死性筋膜炎: 個案報告
 陳奕宏、林永明

 

A 74-year-old patient presented to the Emergent Department with progressive dyspnea for 3 days. Physical examination demonstrated gangrenous change in prepuce, scrotum, perineum, suprapubic area and bilateral inguinal area. Emergent debridement was performed and cystoscopy showed total obstruction in distal urethra. Suprapubic cystostomy was done then. During the procedure, one small chicken bone was found in perineal necrotic tissue. On the next day, T-colostomy and another debridement were conducted. One defect of corpus spongiosum and proximal penile urethra was suspected in the operation. In the third debridement, 7 x 1cm plastic roll was pulled from the urethral defect and cystoscopy showed no other foreign body in his lower urinary tract. According to his family’s statement, he seemed to habitually insert a foreign body into his urethra. Psychiatrist was consulted but no specific psychological disorder was impressed, except urethralism.

FTSG was performed to achieve reconstruction of skin and soft tissue defect involved by Fournier’s gangrene. Primary closure of urethra and corpus spongiosum was used to repair the urethral defect. However, wound dehiscence developed one week after defect closure. Buccal mucosa with soft tissue onlay graft was suggested to treat the urethral defect. But the patient satisfied with bladder emptying from urethral defect which provided better voiding function after removal of Foley.

It was a rare complication of self insertion of foreign body in urethra - chronic urethral erosion was followed by urethral rupture which induced Fournier’s gangrene. Basic principles in treatment of Fournier's gangrene are comprised of initial resuscitation, broad-spectrum antibiotics therapy, and early aggressive debridement. In this case, early urinary diversion, identification of infection source and aggressive debridement provided excellent prognosis in this patient.