Gangrena de Fournier en portador de catéter doble jota

Abstract

Case report: A 30-year-old male patient, with a history of endoscopic ureterolithotomy plus placement of a double J catheter for 5 years. The clinical examination showed edema, redness, and heat that extended to the base and shaft of his penis. Laboratory tests, soft tissue ultrasound and Urotac were performed, showing a 30-cc collection at the base of the penis with debris inside, and gas area in the soft tissues in front of the pubic area and at the base of the penis. Surgery was performed with the intention of draining the abscess and taking a sample for culture, testing positive for Escherichia coli. The diagnosis was Fournier's gangrene. In-hospital management was performed, including broad spectrum coverage with Piperacillin / Tazobactam.

Relevance: Fournier's gangrene is a progressive necrotizing, soft tissues infection, affecting the external genitals and/or perineum. It generally occurs in older men and is considered a urological emergency due to its rapid progression and high lethality; even under the administration of broad-spectrum antibiotics and extensive surgical debridement, it could be fatal. Among its predisposing factors are diabetes mellitus, kidney failure, obesity, alcoholism, hallucinogens, steroids, smoking, cancers, and HIV.

Clinical implications: Main implications of this case are related to a better control, and surveillance to patients with double J catheter. It is recommended the removal of these devices within the appropriate period of time, in order to decrease the risk of complications such as Fournier’s gangrene due to its inadequate utilization.

Conclusion: Fournier's gangrene could be associated with the use of double J catheter, which is a medical device frequently used in the urology area. Therefore, this device should be removed from all patients at the indicated times, reducing the probability of suffering from this infection.