{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T05:07:31Z","timestamp":1769058451773,"version":"3.49.0"},"reference-count":29,"publisher":"International College of Surgeons","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:p>Fournier gangrene is a necrotizing soft tissue infection involving the perineum. We present a case of Fournier gangrene as the clinical presentation of perforated metastatic rectal cancer. The patient is a 78-year-old man in a nursing home who presented to our institution with necrosis and ischemia of the scrotum. After wide debridement of necrotic tissue and bilateral orchiectomy, computed tomography was carried out to investigate abnormal findings seen on his chest X-ray, which revealed multiple pulmonary metastases as well as a mass highly suspicious for a perforated rectal mass. Once stable, a diverting colostomy and biopsies of the rectal mass were performed, confirming the presence of a metastatic, poorly differentiated rectal adenocarcinoma. Albeit an unusual etiology of Fournier gangrene, this case highlights the rare but important causes of this deadly condition and teaches us to be cognizant of the variations in the presentation of colorectal cancer.<\/jats:p>","DOI":"10.9738\/cc168.1","type":"journal-article","created":{"date-parts":[[2013,2,25]],"date-time":"2013-02-25T19:39:56Z","timestamp":1361821196000},"page":"43-48","source":"Crossref","is-referenced-by-count":10,"title":["Fournier Gangrene as a Manifestation of Undiagnosed Metastatic Perforated Colorectal Cancer"],"prefix":"10.9738","volume":"98","author":[{"given":"Cyrus C.","family":"Chan","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallory","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Toledo Medical Center, Toledo, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4721","reference":[{"issue":"1","key":"i0020-8868-98-1-43-b01","series-title":"J Urol","first-page":"89","article-title":"Outcome prediction in patients with Fournier gangrene","volume":"154","author":"Laor\n              E ,","year":"1995","unstructured":"Laor\n              E , \n            \n              Palmer\n              LS , \n            \n              Tolia\n              BM , \n            \n              Reid\n              RE , \n            \n              Winter\n              HI . \n          \n          Outcome prediction in patients with Fournier gangrene . J Urol1995 ;154(1) :89 \u201392"},{"key":"i0020-8868-98-1-43-b02","series-title":"Sem Med","first-page":"345","article-title":"Overwhelming gangrene [in French]","volume":"3","author":"Fournier\n              AJ .","year":"1883","unstructured":"Fournier\n              AJ . \n          \n          Overwhelming gangrene [in French] . Sem Med . 1883 ;3 :345"},{"issue":"11","key":"i0020-8868-98-1-43-b03","series-title":"JAAPA","first-page":"44","article-title":"Fournier gangrene: be alert for this medical emergency","volume":"20","author":"Burch\n              DM ,","year":"2007","unstructured":"Burch\n              DM , \n            \n              Barreiro\n              TJ , \n            \n              Vanek\n              VW . \n          \n          Fournier gangrene: be alert for this medical emergency . JAAPA2007 ;20(11) :44 \u201347"},{"issue":"6","key":"i0020-8868-98-1-43-b04","series-title":"Br J Surg","first-page":"718","article-title":"Fournier gangrene: a review of 1726 cases","volume":"87","author":"Eke\n              N .","year":"2000","unstructured":"Eke\n              N . \n          \n          Fournier gangrene: a review of 1726 cases . Br J Surg2000 ;87(6) :718 \u2013728"},{"issue":"1","key":"i0020-8868-98-1-43-b05","series-title":"Urol Clin North Am","first-page":"149","article-title":"Gangrene and Fournier gangrene","volume":"19","author":"Paty\n              R ,","year":"1992","unstructured":"Paty\n              R , \n            \n              Smith\n              AD . \n          \n          Gangrene and Fournier gangrene . Urol Clin North Am1992 ;19(1) :149 \u2013162"},{"issue":"3","key":"i0020-8868-98-1-43-b06","series-title":"Br J Urol","first-page":"347","article-title":"Fournier gangrene","volume":"81","author":"Smith\n              GL ,","year":"1998","unstructured":"Smith\n              GL , \n            \n              Bunker\n              CB , \n            \n              Dinneen\n              MD . \n          \n          Fournier gangrene . Br J Urol1998 ;81(3) :347 \u2013355"},{"issue":"12","key":"i0020-8868-98-1-43-b07","series-title":"Medscape Reference","first-page":"342","article-title":"Fournier Gangrene","volume":"24","author":"Santora\n              T ,","year":"2012","unstructured":"Santora\n              T , \n            \n              Schwartz\n              BF . \n          \n          Fournier Gangrene . Medscape Reference2012 ;24(12) :342 \u2013349"},{"issue":"1","key":"i0020-8868-98-1-43-b08","series-title":"Surg Gynecol Obstet","first-page":"49","article-title":"Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia","volume":"170","author":"Clayton\n              MD ,","year":"1990","unstructured":"Clayton\n              MD , \n            \n              Fowler\n              JE\n              Jr , \n            \n              Sharifi\n              R , \n            \n              Pearl\n              RK . \n          \n          Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia . Surg Gynecol Obstet1990 ;170(1) :49 \u201355"},{"key":"i0020-8868-98-1-43-b09","series-title":"J Urol","first-page":"944","article-title":"Validation of the Fournier Gangrene Severity Index in a Large Contemporary Series","volume":"180","author":"Corcoran\n              AT ,","year":"2008","unstructured":"Corcoran\n              AT , \n            \n              Smaldone\n              MC , \n            \n              Gibbons\n              EP , \n            \n              Walsh\n              TJ , \n            \n              Davies\n              BJ . \n          \n          Validation of the Fournier Gangrene Severity Index in a Large Contemporary Series . J Urol2008 ;180 :944 \u2013948"},{"issue":"5","key":"i0020-8868-98-1-43-b10","series-title":"Dis Colon Rectum","first-page":"649","article-title":"Outcome analysis in patients with Fourniers gangrene: report of 45 cases","volume":"46","author":"Korkut\n              M ,","year":"2003","unstructured":"Korkut\n              M , \n            \n              Icoz\n              G , \n            \n              Dayangac\n              M , \n            \n              Akgun\n              E , \n            \n              Yeniay\n              L , \n            \n              Erdogan\n              O , \n            \n              Cal\n              C . \n          \n          Outcome analysis in patients with Fourniers gangrene: report of 45 cases . Dis Colon Rectum2003 ;46(5) :649 \u2013652"},{"issue":"10","key":"i0020-8868-98-1-43-b11","series-title":"Actas Urol Esp","first-page":"24","article-title":"Fournier gangrene: evaluation of prognostic factors in 90 patients [in Spanish]","volume":"32","author":"Medina\n              JP ,","year":"2008","unstructured":"Medina\n              JP , \n            \n              Tejido\n              SA , \n            \n              de la Rossa\n              KF . \n          \n          Fournier gangrene: evaluation of prognostic factors in 90 patients [in Spanish] . Actas Urol Esp2008 ;32(10) :24 \u201330"},{"issue":"4","key":"i0020-8868-98-1-43-b12","series-title":"Urol Clin North Am","first-page":"841","article-title":"Fournier disease","volume":"26","author":"Vick\n              R ,","year":"1999","unstructured":"Vick\n              R , \n            \n              Carson\n              CC . \n          \n          Fournier disease . Urol Clin North Am1999 ;26(4) :841 \u2013849"},{"key":"i0020-8868-98-1-43-b13","series-title":"Acta Chir Belg","first-page":"329","article-title":"Fournier gangrene: first manifestation of occult rectal cancer","volume":"111","author":"Ruiz-Tovar\n              J ,","year":"2011","unstructured":"Ruiz-Tovar\n              J , \n            \n              Cordoba\n              L , \n            \n              Devesa\n              JM . \n          \n          Fournier gangrene: first manifestation of occult rectal cancer . Acta Chir Belg2011 ;111 :329 \u2013331"},{"issue":"30","key":"i0020-8868-98-1-43-b14","series-title":"J of Clin Onc","first-page":"e605","article-title":"Perforated rectal cancer presenting as Fournier gangrene","volume":"28","author":"Carr\n              JA .","year":"2010","unstructured":"Carr\n              JA . \n          \n          Perforated rectal cancer presenting as Fournier gangrene . J of Clin Onc2010 ;28(30) :e605 \u2013606"},{"key":"i0020-8868-98-1-43-b15","series-title":"Cases J","first-page":"9136","article-title":"Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report","volume":"2","author":"Moslemi\n              MK ,","year":"2009","unstructured":"Moslemi\n              MK , \n            \n              Gilani\n              MAS , \n            \n              Moslemi\n              AA , \n            \n              Arabshahi\n              A . \n          \n          Fournier gangrene presenting in a patient with undiagnosed rectal adenocarcinoma: a case report . Cases J2009 ;2 :9136"},{"issue":"4","key":"i0020-8868-98-1-43-b16","series-title":"Chirurgia (Bucur)","first-page":"395","article-title":"[Fournier gangrene \u2013 atypical onset for lower rectal cancer]","volume":"100","author":"Onita\n              M ,","year":"2005","unstructured":"Onita\n              M , \n            \n              Hornung\n              E , \n            \n              Ciobanu\n              C , \n            \n              Olariu\n              T , \n            \n              Onita\n              C . \n          \n          [Fournier gangrene \u2013 atypical onset for lower rectal cancer] . Chirurgia (Bucur)2005 ;100(4) :395 \u2013399"},{"issue":"5","key":"i0020-8868-98-1-43-b17","series-title":"Emerg Radiol","first-page":"295","article-title":"CT findings of perforated rectal carcinoma presenting as Fournier gangrene in the emergency department","volume":"11","author":"Ash\n              L ,","year":"2005","unstructured":"Ash\n              L , \n            \n              Hale\n              J . \n          \n          CT findings of perforated rectal carcinoma presenting as Fournier gangrene in the emergency department . Emerg Radiol2005 ;11(5) :295 \u2013297"},{"issue":"97","key":"i0020-8868-98-1-43-b18","series-title":"Pol Merkur Lekarski","first-page":"62","article-title":"[Fournier gangrene in non-resectable colorectal carcinoma]","volume":"17","author":"Wronski\n              M ,","year":"2004","unstructured":"Wronski\n              M , \n            \n              Malyszka\n              K , \n            \n              Pawlowski\n              W . \n          \n          [Fournier gangrene in non-resectable colorectal carcinoma] . Pol Merkur Lekarski2004 ;17(97) :62 \u201363"},{"key":"i0020-8868-98-1-43-b19","series-title":"Am J Gastroenterol","first-page":"657","article-title":"Fournier gangrene: An unusual presentation for rectal carcinoma","volume":"93","author":"Gamagami\n              RA ,","year":"1998","unstructured":"Gamagami\n              RA , \n            \n              Mostafavi\n              M , \n            \n              Gamagami\n              A\n            \n            et al\n           . Fournier gangrene: An unusual presentation for rectal carcinoma . Am J Gastroenterol1998 ;93 :657 \u2013658"},{"issue":"4","key":"i0020-8868-98-1-43-b20","series-title":"Eur J Surg Oncol","first-page":"367","article-title":"Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier gangrene","volume":"23","author":"Gould\n              SW ,","year":"1997","unstructured":"Gould\n              SW , \n            \n              Banwell\n              P , \n            \n              Glazer\n              G . \n          \n          Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier gangrene . Eur J Surg Oncol1997 ;23(4) :367 \u2013368"},{"key":"i0020-8868-98-1-43-b21","series-title":"Am J Roentgenol","first-page":"1164","article-title":"Necrotizing fasciitis of the scrotum (Fournier's gangrene)","volume":"166","author":"Fan\n              CM ,","year":"1996","unstructured":"Fan\n              CM , \n            \n              Whitman\n              GJ , \n            \n              Chew\n              FS . \n          \n          Necrotizing fasciitis of the scrotum (Fournier's gangrene) . Am J Roentgenol1996 ;166 :1164"},{"issue":"2","key":"i0020-8868-98-1-43-b22","series-title":"Urol Int","first-page":"186","article-title":"Fournier gangrene: our approach and patients","volume":"87","author":"Fajdic\n              J ,","year":"2011","unstructured":"Fajdic\n              J , \n            \n              Gotovac\n              N , \n            \n              Hrgovic\n              Z . \n          \n          Fournier gangrene: our approach and patients . Urol Int2011 ;87(2) :186 \u2013191"},{"key":"i0020-8868-98-1-43-b23","series-title":"Eur Urol","first-page":"572","article-title":"Fournier gangrene: an analysis of repeated surgical debridement","volume":"43","author":"Chawla\n              SN ,","year":"2003","unstructured":"Chawla\n              SN , \n            \n              Gallop\n              C , \n            \n              Mydlo\n              JH . \n          \n          Fournier gangrene: an analysis of repeated surgical debridement . Eur Urol2003 ;43 :572"},{"issue":"3 pt 1","key":"i0020-8868-98-1-43-b24","series-title":"J Urol","first-page":"837","article-title":"Hyperbaric oxygen therapy in the treatment of Fournier disease in 11 male patients","volume":"158","author":"Pizzorno\n              R ,","year":"1997","unstructured":"Pizzorno\n              R , \n            \n              Bonini\n              F , \n            \n              Donelli\n              A , \n            \n              Stubinski\n              R , \n            \n              Medica\n              M , \n            \n              Carmignani\n              G . \n          \n          Hyperbaric oxygen therapy in the treatment of Fournier disease in 11 male patients . J Urol1997 ;158(3 pt 1) :837 \u2013840"},{"issue":"1","key":"i0020-8868-98-1-43-b25","series-title":"Int J Colorectal Dis","first-page":"48","article-title":"Necrotizing perineal infections (Fournier disease): old remedies for an old disease","volume":"13","author":"Nomikos\n              IN .","year":"1998","unstructured":"Nomikos\n              IN . \n          \n          Necrotizing perineal infections (Fournier disease): old remedies for an old disease . Int J Colorectal Dis1998 ;13(1) :48 \u201351"},{"issue":"9","key":"i0020-8868-98-1-43-b26","series-title":"World J Surg","first-page":"1750","article-title":"Fournier gangrene: risk factors and strategies for management","volume":"30","author":"Yanar\n              H ,","year":"2006","unstructured":"Yanar\n              H , \n            \n              Taviloglu\n              K , \n            \n              Ertekin\n              C , \n            \n              Guloglu\n              R , \n            \n              Zorba\n              U , \n            \n              Cabioglu\n              N , \n            \n              Baspinar\n              I . \n          \n          Fournier gangrene: risk factors and strategies for management . World J Surg2006 ;30(9) :1750 \u20131754"},{"issue":"6","key":"i0020-8868-98-1-43-b27","series-title":"Intensive Care Med","first-page":"970","article-title":"Serum lactate as a predictor of mortality in patients with infection","volume":"33","author":"Trzeciak\n              S ,","year":"2007","unstructured":"Trzeciak\n              S , \n            \n              Dellinger\n              RP , \n            \n              Chansky\n              ME , \n            \n              Arnold\n              RC , \n            \n              Schorr\n              C , \n            \n              Micarek\n              B\n            \n            et al\n           . Serum lactate as a predictor of mortality in patients with infection . Intensive Care Med2007 ;33(6) :970 \u2013977"},{"issue":"8","key":"i0020-8868-98-1-43-b28","series-title":"Am Surg Aug","first-page":"709","article-title":"Management of Fournier gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment","volume":"68","author":"Norton\n              KS ,","year":"2002","unstructured":"Norton\n              KS , \n            \n              Johnson\n              LW , \n            \n              Perry\n              T , \n            et al\n           . Management of Fournier gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment . Am Surg Aug2002 ;68(8) :709 \u201313"},{"issue":"4","key":"i0020-8868-98-1-43-b29","series-title":"Infection","first-page":"306","article-title":"New insights into the epidemiology and etiology of Fournier gangrene: a review of 33 patients","volume":"37","author":"Czymek\n              R ,","year":"2009","unstructured":"Czymek\n              R , \n            \n              Hildebrand\n              P , \n            \n              Kleemann\n              M\n            \n            et al\n           . New insights into the epidemiology and etiology of Fournier gangrene: a review of 33 patients . Infection2009 ;37(4) :306 \u2013312"}],"container-title":["International Surgery"],"original-title":[],"link":[{"URL":"https:\/\/international-surgery.kglmeridian.com\/view\/journals\/insu\/98\/1\/article-p43.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/international-surgery\/article-pdf\/98\/1\/43\/2214046\/cc168_1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/international-surgery.kglmeridian.com\/downloadpdf\/journals\/insu\/98\/1\/article-p43.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/international-surgery.kglmeridian.com\/downloadpdf\/journals\/insu\/98\/1\/article-p43.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T18:59:43Z","timestamp":1751482783000},"score":1,"resource":{"primary":{"URL":"https:\/\/international-surgery.kglmeridian.com\/view\/journals\/insu\/98\/1\/article-p43.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013]]},"references-count":29,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.9738\/cc168.1","relation":{},"ISSN":["0020-8868","2520-2456"],"issn-type":[{"value":"0020-8868","type":"print"},{"value":"2520-2456","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013]]}}}