ABSTRACT
Between 1989 and 1993, nine patients with Fournier's gangrene presented to our institution. The mean patient age was 66 years. The source of infection was dermal in five cases, urethral in three cases and rectal in one case. Potential contributing factors included diabetes mellitus in six cases, alcohol abuse in four cases and drug-induces immunosuppression in two cases. In every patient, tissue cultures revealed mixed aerobic and anaerobic infections. All patients were treated initially with aggressive surgical debridement and culture-specific intravenous antibiotics. One patient required multiple debridements. Reconstruction by split-thickness skin grafts was performed in eight cases and one healed by secondary intention. There were no deaths due to progressive infection. The mortality rate was 11% with six month follow-up. The favorable outcome of patients in this series supports the current recommendation for early, aggressive surgical debridement and culture-specific, intravenous antibiotic therapy.
ABSTRACT
We report the case of an intoxicated male patient who presented with an isolated intraperitoneal urinary bladder rupture, with a history of minor trauma. A review of the literature reveals that isolated bladder rupture after minimal or no trauma in association with alcohol or drug ingestion is an infrequently reported, but recognized, injury. The diagnosis of bladder rupture should be considered in an intoxicated patient with lower abdominal pain, even without a history of trauma. A history of voiding or bladder dysfunction should increase the suspicion for this injury. If suspected, a retrograde cystogram should be obtained promptly. Failure to consider and recognize this injury may lead to significant morbidity.
