pISSN 2671-8790 eISSN 2671-8804

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Korean J Transplant 2021; 35(3): 195-199

Published online September 30, 2021

https://doi.org/10.4285/kjt.21.0013

© The Korean Society for Transplantation

Selected deceased donor liver transplantation in controlled Fournier’s gangrene: a case report

Byeong Gwan Noh1 , Nuri Lee2 , Byoung Chul Lee3 , Myunghee Yoon4

1 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Pusan National University Hospital, Busan, Korea
2Department of Surgery, Veterans Health Service Medical Center, Seoul, Korea
3Division of Colorectal Surgery, Department of Surgery, Pusan National University Hospital, Busan, Korea
4 Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

Correspondence to: Myunghee Yoon
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea
Tel: +82-51-240-7238
Fax: +82-51-247-1365
E-mail: ymh@pusan.ac.kr

Received: June 7, 2021; Revised: July 26, 2021; Accepted: July 27, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bacterial infection represents a turning point in the natural history of cirrhosis, causing the development of acute-on-chronic liver failure. It significantly affects the outcome of patients listed for liver transplantation. We report the case of a 57-year-old man who had been regularly treated for hepatitis B virus, alcoholic liver cirrhosis, and hepatic failure. The patient was hospitalized again due to variceal bleeding and hepatic coma. He visited the emergency room with painful anal swelling, dysuria, icteric sclera, and serious abdominal distension. The painful anal swelling and necrosis progressed; thus, he was diagnosed with Fournier’s gangrene. Enterococcus faecium and Candida albicans were detected in the blood. Gangrene wound debris was studied extensively. Despite appropriate antibiotic treatment, vancomycin-resistant enterococcus and C. albicans were continuously present in the blood. Wide debridement of the wound and T-colostomy were performed. After this, norepinephrine and vasopressin were used to maintain stable vital signs. It was difficult to establish a liver transplant operation. Despite repeated bleeding, bacterial infections improved with additional antibiotics. Finally, selected deceased donor liver transplantation in controlled Fournier’s gangrene was successfully performed. Controlled infections may be allowed in transplantation surgery.

Keywords: Fournier gangrene, Variceal bleeding, Cirrhosis, Liver transplantation, Case report

HIGHLIGHTS
  • According to recent studies, selected patients with “controlled infection” should be considered for transplant, because this condition does not impair the posttransplant outcome.