ABSTRACT
Fournier's gangrene is a severe, life-threatening form of necrotizing fasciitis that predominantly affects the perineal, genital, and perianal areas. It is characterized by a rapid onset and progression, often developing from urogenital infections, diabetes, compromised immune function, or trauma. This report describes the case of a 64-year-old woman who presented with perianal pain and purulent discharge persisting for a week. Upon examination, a substantial necrotic wound was identified in her perineal region, necessitating urgent surgical debridement followed by aggressive postoperative management, including antibiotic therapy and meticulous blood sugar control. Despite initial signs of improvement, the patient's condition deteriorated due to complications from diabetes, acidosis, and pneumonia, ultimately leading to a fatal outcome. This case highlights the critical need for prompt recognition and comprehensive management of Fournier's gangrene, particularly in female patients exhibiting similar symptoms.
ABSTRACT
BACKGROUND Chyle leakage with chylous ascites is a rare complication of abdominal surgery, and few cases have been reported following cholecystectomy. This report is of a 64-year-old man with chyle leak following laparoscopic cholecystectomy and describes the diagnosis and approach to treatment. Immediate diagnosis, although challenging, remains imperative. Frequently, patients manifest nonspecific symptoms, such as abdominal discomfort or nausea. They can also exhibit milky discharge from drains and wounds. Abdominal fluid analysis is fundamental for diagnosis. The existence of elevated triglyceride levels in peritoneal fluid is indicative of chyle leakage. CASE REPORT We present a case report of a 64-year-old man with chyle leakage after laparoscopic cholecystectomy for acute cholecystitis, on postoperative day 2. A milky-white fluid was drained, and diagnosis was confirmed with elevated triglycerides upon fluid analysis. Chyle leakage decreased gradually until complete resolution at postoperative day 7, after dietary modifications and the closed-suction silicone drain was removed. The patient was symptom-free at a 2-month follow-up. CONCLUSIONS Although chyle leakage is a rare postoperative complication of laparoscopic cholecystectomy, early diagnosis and rapid multidisciplinary management are required. It is vital to consider this diagnosis even if the course of laparoscopic cholecystectomy was uncomplicated and with no anatomical variation. Thus, a closed-suction silicone drain and close monitoring of output is essential for early diagnosis. The dietary modification constitutes a cornerstone in the management of chyle leakage, and a surgical approach should be preserved for patients for whom the conservative approach fails or who have large volumes of chyle.
