Карточка-задание по английскому языку на тему «MEDICAL WRITING: CASE ABSTRACT_265»
«MEDICAL WRITING: CASE ABSTRACT_265»
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A multistep approach to
manage Fournier’s gangrene in a patient with unknown type II diabetes: surgery,
hyperbaric oxygen, and vacuum-assisted closure therapy: a case report
Fournier’s gangrene is an
infectious necrotizing fasciitis of the perineum and genital regions and has a
high mortality rate. It is a synergistic infection caused by a mixture of
aerobic and anaerobic organisms and predisposing factors, including diabetes
mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a
case of Fournier’s gangrene in a patient with unknown type II diabetes
submitted to 24-hour catheterization 15 days before gangrene onset.
The patient, a 60-year-old
Caucasian man, presented with a swollen, edematous, emphysematous scrotum with
a crepitant skin and a small circle of necrosis. A lack of resistance along the
dartos fascia of the scrotum and Scarpa’s lower abdominal wall fascia combined
with the presence of gas and pus during the first surgical debridement also
supported the diagnosis of Fournier’s gangrene. On the basis of the
microbiological culture, the patient was given multiple antibiotic therapy,
combined hypoglycemic treatment, hyperbaric oxygen therapy, and several
surgical debridements. After five days the infection was not completely
controlled and a vacuum-assisted closure device therapy was started.
This report describes the
successful multistep approach of an immediate surgical debridement combined
with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted
closure is a well-known method used to treat complex wounds. In this case
study, vacuum-assisted closure treatment was effective and the patient did not
require reconstructive surgery. Our report shows that bladder catheterization,
a minimally invasive maneuver, may also cause severe infective consequences in
high-risk patients, such as patients with diabetes.
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