Concluded Case

Case of fournier's gangrene

Patient presented with history of right below knee amputation , DKA+ Drowsy Fever. Pain and swelling in the genitals or anal area. Unpleasant odor coming from the affected skin tissue. Crackling sound when touching the affected area.

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It is case of Fournier' s gangrene with diabetic ketoacidosis. As such Fournier's gangrene is a life threating disease as it may land to septicaemic shock and thus has bees aggravated by diabetis with ketoacidosis , pt leading to multi organ failure . Pt is drowsy beacuse of diabetes as insulin not being used to neutralise glucose the fuel but here fuel is used from fat due to exessive break down of fat in the form of ketone and thus blood become acidic Treatment A. To treat high blood sugar by insulin drip and to treat excessive fluid loss for too much of urination B correction of electrolytes imbalance mainly potassium by calculated dose Indwelling catheter to see the kidney function Antibiotic higher parenteral inj Ceftraixone 1 gm + Salbactum 500 iv bd Inj Metrogyl 100 tds Total ruthless debribement of the scrotal wound till normal tissue is seen by this testes may be denuded may be implanted in pouch made upper medial side of thigh. If proper care not being taken or taken prognosis is grave may lead to pulmonary oedema or cardiac arrest

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It is case of Fournier' s gangrene with diabetic ketoacidosis. As such Fournier's gangrene is a life threating disease as it may land to septicaemic shock and thus has bees aggravated by diabetis with ketoacidosis , pt leading to multi organ failure . Pt is drowsy beacuse of diabetes as insulin not being used to neutralise glucose the fuel but here fuel is used from fat due to exessive break down of fat in the form of ketone and thus blood become acidic Treatment A. To treat high blood sugar by insulin drip and to treat excessive fluid loss for too much of urination B correction of electrolytes imbalance mainly potassium by calculated dose Indwelling catheter to see the kidney function Antibiotic higher parenteral inj Ceftraixone 1 gm + Salbactum 500 iv bd Inj Metrogyl 100 tds Total ruthless debribement of the scrotal wound till normal tissue is seen by this testes may be denuded may be implanted in pouch made upper medial side of thigh. If proper care not being taken or taken prognosis is grave may lead to pulmonary oedema or cardiac arrest

Thanks Dr P G Shah
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Fournier's gangrene with DKA,. It is a serious emergency and if not treated aggressively- you may lose the,patient. A combination of Fournier 's gangrene and DKA is deadly . A combined team work is needed between General surgeon , physician and an intensive care specialist. Start with IV line - correct dehydration and electrolyte disturbance Insulin in drip along with Potassium as per the need Parenteral antibiotics Inj Piperacillin 4 gm + tazobactum 500 mg × 6 hourly If creatinine is normal inj Amikacin can be added . Shift the patient to O.T - once stable and glycaemic control is achieved Adequate debridement is indicated- removing all the necrotic and non - viable tissue and slough . Even if testis are denuded- debridement should continue Later on skin grafting or testis can be implanted in a Sub - cutaneous pouch created in upper medial thigh Before doing debridement- patient needs,to be catheterised with Foley s catheter

Fourniers gangrene is serious type of necrotising fascitis Gas gangrene type of infection Fatal disease prognosis bad

Necrotising fasciitis, excise neurotic tissue

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