Sierra-Peláez ÓA, Vélez-Román JC, Infante-Burgos RJ, Umaña-Peña MJ

Language: Spanish
References: 12
Page: 1-10
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ABSTRACT

Case report: A 30-year-old male patient with a history of endoscopic ureterolithotomy 5 years ago along with the placement of a double J catheter. On clinical examination, swelling, redness, and warmth extending to the base and body of the penis were observed. Laboratory tests, soft tissue ultrasound, and Urotomography were performed, revealing findings of gas necrosis and accumulation of debris in the perineal area and the base of the penis. Surgical drainage was performed, yielding positive results for Escherichia coli. The diagnosis was Fournier’s gangrene. Intrahospital management was carried out, including broad-spectrum coverage for 14 days, with a progressive decrease in leukocytes and partial wound resolution, followed by medical discharge. The patient received outpatient management and follow-up at the wound clinic, resulting in successful resolution.
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: The main practical implications of this report are related to increased control, monitoring, and surveillance of patients with double J catheters. In this regard, it is suggested that such medical devices, which are used in urology, be removed at the established times, reducing the probability of complications and infections due to improper use..
Conclusion: The retained double J catheter for 5 years could potentially be associated as a causative agent of Fournier’s gangrene, especially considering the absence of underlying medical conditions, with this surgical history being the most relevant factor, supported by the results obtained from secretion culture and urine culture. Therefore, all patients who have such devices, commonly used in urology, should undergo timely extraction to reduce the probability of developing complications and/or any type of infection.

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