Presentation on theme: "PENILE GANGRENE following bite"— Presentation transcript:
1 PENILE GANGRENE following bite Ukraine,Lviv National Medical University named after Danylo Halytskyi(Department of Urology )PENILE GANGRENE following biteMytsyk YulianAssoc. Proff., Ph.D.
2 Case reportPatient, 32 years old, was admitted to the Lviv’s Emergency hospital, department of Urology with complaints on the:intensive penis ache,penis hyperemia and edema,fever, body temperature was about 400 C,perspiration, malaise,urination was not complicated.In patients history- penis bite during sexual relationships 2 days beforehand
3 Fig 1. During inspection – hyperemic painful penis, extensive edema and pigmentation in the injury area which were rapidly spreading.
4 Fig 2. Recognizing rapid progression of the penis tissues necrosis it was settled to perform surgical treatment with excision of the necrotized tissues immediately.
5 Fig 3. On the beginning of the surgical treatment (1 hour following admittance) edema and pigmentation of the penis tissues have spread on the whole organ which is characteristic for the acute penile gangrene according to the different author’s data.
6 Fig 4. All necrotized tissues were excised Fig 4. All necrotized tissues were excised. The absence of the necrotic process spreading directly on the penis corpus was revealed during the operation, which consequently stipulated the selective excision of the skin layers over the organ
7 Fig 4. Two contra-apertures were created in the pubic area through which a draining tubes with outputs around penis basis were introduced. After final wound area dressing the operation was completed.
8 Before, during and after surgery the patient was prescribed an intensive anti-inflammatory therapy using antibiotic of wide spectrum; desintoxication and anti-pain therapy)Postoperative period was without significant complications and extensive purulent wound discharge. The signs of intoxication were diminishing progressively until the complete cessation on the 8-th day. The drainage tubes were extracted on the 6-th day after operation.
9 Fig 5. 10-th day after surgery. The penis wound area was covered with granulation tissue on the 20th day after surgical operation; the hyperemia and edema were insignificant. The patient was discharged on the 22nd day for outpatient follow-up.A reconstructive plastic surgery was recommended to the patient from which he refused.
10 DiscussionPenile gangrene (PG) is rare, but extremely complicated disease which is predisposed to fast progression and spreading creating the life-threatening condition for the patient. Lethality is 50-90%.Penile gangrene may be caused by paraphimosis or compression with ring-shaped objects which leads to the impairment of the blood supply and infectious complications. It some cases sex-caused trauma occures.The highest incidence of the penis gangrene occurs in severely immune compromised patients and patients with diabetes mellitus.Often plastic surgery is required in a some time after the primary surgical treatment.
11 This case confirmed that penile gangrene is the disease which is followed by severe intoxication and predisposed to fast progression;Immediate surgical intervention with excision of the necrotizing tissues allows to prevent the scrotal, perineal and anterior abdominal wall spreading of the necrotic process;In some cases the necrotic process involves only superficial tissues which preconditions organ-sparing operation and consequently increases patients life quality;Use of wide spectrum antibiotics and desintoxication therapy before, during and after surgery is essential to prevent further developing of tissue necrosis and septical complications.