The Patient Hides the Truth, but the Computer Tomography Examination Restores It!

Abstract

In this article, we present the case of a patient who hid the real reason for which he came to the emergency room. This patient in this case is a 61-year-old man, who presented to the emergency department for symptoms relevant to respiratory disease. However, the initial diagnosis turned out to be only the “tip of the iceberg” in the evolution and treatment of this patient. Fournier gangrene is a fulminant form of infectious necrotizing fasciitis of the perineal, genital, or perianal regions, which frequently affects men, but can also occur in women and children. It is a rare but life-threatening disease. Due to potential complications, it is important to diagnose Fournier gangrene as early as possible. Although antibiotics and aggressive debridement have been widely accepted as standard treatment, the mortality rate remains high. In many cases, the doctor’s mission is much more difficult than it first seems. The challenges to which the doctor is subjected, especially in the emergency room, are immense. In establishing a diagnosis and emergency treatment, all parties involved—medical staff, on the one hand, and patients and relatives, on the other hand—must collaborate so that the outcome is a positive one. The overall conclusion of the medical team was that Fournier gangrene in the patient was the consequence of both the presence of an intrarectal foreign body, as well as excessive alcohol consumption. The case of our patient with Fournier gangrene and an intrarectal foreign body had a positive outcome due to quick, aggressive, and adequate medical and surgical management, as well as the fact that the patient had no other associated pathologies beyond alcohol “passion.” Our patient’s case is an example of the exceptional situations we sometimes encounter in medical practice.

Keywords

• Fournier gangrene
• anorectal trauma
• intrarectal foreign object