Rectal cancer and Fournier’s gangrene - current knowledge and therapeutic options

Figure 1 Diagnostic-therapeutic algorithm for suspected/proven Fournier’s gangrene due to rectal cancer. Perioperative management and necrosectomy are excluded which are standard procedures in Fournier’s gangrene treatment in all patients. ¹Impalpable perforation does not exclude microperforation; ²(1) Blood (any form) on digital rectal examination; (2) history and other/previous diagnostic modalities refer to rectal carcinoma; (3) urogenital and dermatological causes excluded; (4) bacteria highly specific for (intestinal) rectal malignancy such as Clostridium septicum; and (5) fever or sepsis of unknown origin with perianal symptoms/signs; ³Increased soft tissue density with abscess and/or gas bubbles around the tumor; ⁴After confirmation of rectal cancer, definitive oncological operation is performed after stabilization and neoadjuvant chemoradiotherapy if indicated. Reconstructive surgery after consultation with plastic surgeon.