Indexing Title: RDELEON’s Medical Anecdotal Report [04-2]

MAR Title: Fournier'S Gangrene

Date of Medical Observation: March 2004

Narration:

This is a case of SC 73/M who was initially admitted Last March 8, 2003 for Mixed Hemorrhoid. Patient was subsequently operated on March 10, 2004 and operation was essentially unremarkable. He was then discharged the following day.

After about nine days post op, patient went in at the ER with a chief complaint of loose bowel movement and on examination, the operation site was essentially normal and the the scrotal area was noted to have black discoloration. The patient was the diagnosed to have a Fournier's gangrene. He was not operated on immediately and on the morning patient was noted to be having signs of sepsis. And on assessment the patient was directed to OR for radical debridement.

All those time that patient was being brought to the Operating Room and being inducted by Anesthesia Resident, I was praying hoping that things will be alright for the patient. I was really worried that i have to call my parent to ask for prayers for guidance. I never cried that way before and not noticing that some of the people at the operating room saw me crying.

Radical debridement done, but as we were doing the operation, we noted that the gangrene had reached up to the abdominal area and was about to enter the underlying fascial layer. As i saw the site of my patient and the extent of the gangrene, I realized that it was a no win battle. That what ever we do for the patient, the patient will not survive.

Patient was still intubated after operation and at around early in the morning the patient died.

Insights (Discovery, Stimulus, REINFORCEMENT):

As a physician, i learned that given the extent of my knowledge and experience, that there is limitation in my being a doctor. That not all operation will be successful regardless of how we prepared for that operation. And that this tragic thing could have been prevented if I had the knowledge and the skill to identify a fournier's gangrene.