Anorectal trauma associated with sodium phosphate enema leading to Fournier’s gangrene requiring extensive debridement and diverting colostomy

Ms Fiona (Lee) Gavegan1, MS Karen Shedden1, Ms Annelise Cocco1, Dr James W.T. Toh1
1Stoma Therapy, Department of Surgery, Westmead Hospital, Sydney, Australia,

Fournier’s gangrene is a devastating life-threatening condition which is poorly understood. In today’s context, the most common cause of Fournier’s gangrene is perianal abscess followed by urological source – often in elderly, immunocompromised or diabetic patients with significant co-morbidities. However, the first documented genitalia gangrene reported by Baurienne in 1764 described a 14-year old male was gored by an ox, and subsequent early case reports also documented necrotizing perineal sepsis in young healthy men associated with trauma. In this case series, we revisit perianal trauma as a cause for Fournier’s gangrene. More specifically, trauma from administration of phosphate enemas inadvertently leading to Fournier’s gangrene. Within the literature, there have been only a handful of small case series of rectal necrosis associated with phosphate enemas, and rare case reports of Fournier’s gangrene associated with phosphate enema administration. Here we present a 51 year old male who was not diabetic or immunocompromised, and an 84 year old male who was diabetic who developed Fournier’s gangrene after traumatic enema administration. Both patients required extensive debridement of the perineum and scrotum and a diverting colostomy. We review the symptoms, diagnosis, management and sequelae of phosphate enema induced Fournier’s gangrene.


Biography:

Lee Gavegan and Karen Shedden are senior stomal therapists at Westmead Hospital, Sydney, Australia. Dr Annelise Cocco is a senior registrar at Westmead Hospital. Dr James W. T. Toh is a colorectal surgeon at Westmead Hospital and Clinical Senior Lecturer, Westmead Campus, The University of Sydney.