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World J Gastroenterol. Aug 14, 2015; 21(30): 9002-9020
Published online Aug 14, 2015. doi: 10.3748/wjg.v21.i30.9002
Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options
Tomislav Bruketa, Matea Majerovic, Goran Augustin
Tomislav Bruketa, Department of Surgery, University Hospital Center Zagreb, 10000 Zagreb, Croatia
Matea Majerovic, Department of Internal Medicine, University Hospital Center Zagreb, 10000 Zagreb, Croatia
Goran Augustin, Department of Surgery, Division of Gastrointestinal Surgery, University Hospital Center Zagreb and School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
Author contributions: Bruketa T, Majerovic M and Augustin G contributed equally to this work; Augustin G designed the research; Bruketa T and Majerovic M performed the research; Majerovic M analyzed the data; and Bruketa T, Majerovic M and Augustin G wrote the paper.
Conflict-of-interest statement: All the authors declare no conflict of interest regarding the manuscript “Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options”.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Goran Augustin, MD, PhD, Department of Surgery, Division of Gastrointestinal Surgery, University Hospital Center Zagreb and School of Medicine University of Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia. augustin.goran@gmail.com
Telephone: +385-1-2388196 Fax: +385-1-2376020
Received: February 20, 2015
Peer-review started: February 23, 2015
First decision: April 23, 2015
Revised: May 8, 2015
Accepted: June 15, 2015
Article in press: June 16, 2015
Published online: August 14, 2015
Processing time: 177 Days and 16.8 Hours
Abstract

Fournier’s gangrene (FG) is a rapid progressive bacterial infection that involves the subcutaneous fascia and part of the deep fascia but spares the muscle in the scrotal, perianal and perineal region. The incidence has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Pathophysiology and clinical presentation of rectal cancer-induced FG per se does not differ from the other causes. Only rectal cancer-specific symptoms before presentation can lead to the diagnosis. The diagnosis of rectal cancer-induced FG should be excluded in every patient with blood on digital rectal examination, when urogenital and dermatological causes are excluded and when fever or sepsis of unknown origin is present with perianal symptomatology. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed. The survival of patients with rectal cancer resection is reported as 100%, while with colostomy it is 80%. The preferred method of rectal resection has not been defined. Second, oncological treatment should be administered but the timing should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures that are commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.

Keywords: Fournier’s gangrene; Necrotizing fasciitis; Proctological examination; Necrotizing soft tissue infections; Oncological treatment; Rectal cancer; Surgical treatment; Reconstructive surgery

Core tip: The reported incidence of Fournier’s gangrene (FG) has increased dramatically, while the reported incidence of rectal cancer-induced FG is unknown but is extremely low. Therapeutic options are more complex than for other forms of FG. First, the causative rectal tumor should be removed - survival with rectal cancer resection is reported as 100%, while with colostomy it is only 80%. Second, the timing of the oncological treatment should be adjusted to the resolution of the FG and sometimes for the healing of plastic reconstructive procedures commonly needed for the reconstruction of large perineal, scrotal and lower abdominal wall defects.