1 / 15

M & M

M & M. January 7, 2009 Huron Valley Hospital Brent Zamzow DO. ER 12/13/08 CC : scrotal pain, b/l leg swelling HPI : 69  c/o scrotal redness & pain x 1wk. Scrotal swelling on & off for 1yr. B/l leg swelling x 2wks. Rectal pain & fecal urgency attributed to known fistula

ariana-snider
Download Presentation

M & M

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. M & M January 7, 2009 Huron Valley Hospital Brent Zamzow DO

  2. ER 12/13/08 • CC: scrotal pain, b/l leg swelling • HPI: 69 c/o scrotal redness & pain x 1wk. Scrotal swelling on & off for 1yr. B/l leg swelling x 2wks. Rectal pain & fecal urgency attributed to known fistula • PMH: nonrheumatoid arthritis (steroid dependent for 3 years), colitis, rectal fistula, diverticulitis, Bell’s palsy, empyema, chronic anemia, elevated LFTs • PSH: colonoscopy, thoracostomy w/ decortication, cataract, eye muscle surgery • Meds: prednisone, aspirin, motrin prn • Allx: PCN, sulfa

  3. 12/13/08 • PE • 35.9 97/57 103 20 • A&O x3, NAD • Scrotal erythema, tender, swollen; b/l thigh & perineum erythema • Rectal fistula w/ stool draining from R buttock • Labs: • WBC 12.9 • Hgb 9.6 • BUN 37, Cr 1.2 • Na 133, K 3.9, Ca 8.0 • Scrotal US – skin thickening b/l consistent with scrotal cellulitis, b/l hydrocele, dense & inhomogeneous L epididymis • Consults • Urology – scrotal pain • General Surgery – rectal fistula • GI – bloody diarrhea • Infectious Disease – scrotal cellulitis/rectal fistula

  4. 12/13/08 CT – Findings most consistent with Fournier’s gangrene. Gas forming infectious agent with cellulitis in the perineum, scrotum & rectal area. Heterogeneous enhancement of kidneys suggesting pyelonephritis.

  5. 12/13/08 • Presented to ER 11:51am • Admitted 3:12pm • Urology Consult 6:22pm • CT Scan done 7:25pm • CT Scan read 10:01pm • OR 11:50pm • Urology - I&D perineum & scrotum - Fournier’s • Gen Surgery – Lap assisted transverse loop colostomy, debridement perirectal/perianal abscess

  6. What Happened? • Sepsis • Late Presentation with rectal fistula • Lactic Acidosis - shock/hypoperfusion vs dead bowel • Wound care - wound vac • Chronic Steroids • Malnourished

  7. Fournier’s • Mortality avg 20% (7-75%) • Higher if late presentation, DM, alcoholics, colorectal source • Na, Ca, anemia (rbc production)

  8. End

More Related