Contemporary non-surgical approach for faecal diversion in a case of Fournier's gangrene

Stool management in bedridden patients remains a challenge despite the recent advancements in technology aimed at helping patients with faecal incontinence. In this patient scenario, the patient and the caregivers were experiencing the same challenge. Fournier’s Gangrene is a fatal necrotising fasciitis of the perineum, genitals and lower abdomen. Patients often need an aggressive surgical debridement, and in cases, a diverting colostomy. Contamination by faecal micro-organisms can complicate these wounds, especially in elderly patients who present with anal sphincter dysfunction and faecal incontinence. Faecal diversion by creation of a temporary surgical stoma is usually mandated in such cases to expedite wound healing. However, as an invasive procedure it requires a repeat surgery to reverse the stoma. Hence, solutions that can help alleviate the patients from these challenges and expedite the healing process are of crucial importance. Non-surgical catheter-based faecal diversions have been previously reported using a balloon-based silicone rectal tube, but there are chances of injury with its usage. We report the case of a 70-year-old man with multiple comorbidities diagnosed with Fournier’s gangrene, who underwent debridement and had a wound complication due to faecal contamination. A novel, self-expanding rectal device, Qora^TM Stool Management Kit was used to perform faecal diversion, which subsequently showed wound healing within a week and allowing regeneration. This not only prevents deterioration of the wound, but also avoids the morbidity associated with a colostomy and its complications.