Fournier’s Gangrene

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CASE: Fournier’s Gangrene

FACTS: 51-year old male plaintiff was treated by the defendant, internist for severe rectal pain and itching. The defendant made an assessment of hemorrhoids based on the plaintiff’s description of symptoms, without performing an ano-rectal exam, and prescribed topical creams. Due to worsening symptoms, the plaintiff returned to the defendant’s office two days later. Again the defendant did not examine the affected area, instead an abdominal x-ray was ordered. That x-ray revealed no abnormalities but the defendant did nothing further in order to arrive at a definitive diagnosis. As a result the plaintiff’s subcutaneous infection of his peri-rectal area progressed and expanded, becoming a life-threatening form of necrotizing fasciitis called Fournier’s Gangrene, which invaded his scrotum.

DEFENSE: The defendant agreed that the standard of care required an ano-rectal exam on both visits to the defendant’s office, but alleged that the patient refused to permit such an examination. (The medical records made no mention of any such recommendation and refusal, and there were no witnesses to support the defendant’s assertion.)

INJURIES: Plaintiff suffered from Fournier’s Gangrene. He required fifteen surgical procedures, including a transverse diverting colostomy, numerous skin debridements and skin grafts.

SPECIAL DAMAGES: Medical bills: $276,644.07; Lost wages: $20,331.16.

SETTLEMENT: The parties agreed to settle for a confidential amount.

PLANTIFF’S COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC)

NAMES/COUNTY: Anonymous v. Anonymous

CASE: Fournier’s Gangrene

FACTS: The plaintiff sought treatment from the defendants for severe anal pain, which the plaintiff assumed was caused by hemorrhoids. During an office visit, the defendant doctor performed an observation-only physical exam, deferring a rectal exam due to the severity of the plaintiff’s pain, and noted excoriation, skin breakdown, and redness in the perianal area. Presumptively affirming the plaintiff’s self-diagnosis of hemorrhoids, the Defendant doctor prescribed suppositories and topical cream. Two days later, when the plaintiff began developing systemic symptoms, including fever, body aches, and frequent urination, he contacted the defendants’ office and spoke with a triage nurse. No connection was made between the plaintiff’s systemic symptoms and the anal pain for which he had been seen two days prior. Rather, it was assumed that these systemic symptoms presented a new problem – the flu – and the plaintiff was advised to take Tylenol and rest. Three days later, the plaintiff presented to the emergency room, where it was revealed that he suffered from an undiagnosed and untreated infectious process, which progressed to Fournier’s gangrene with very extensive necrosis of his scrotum, perineum, inguinal, perianal, perirectal and penile areas, requiring extensive surgical procedures and medical treatment.

INJURIES: Due to the extent of his necrotizing infection, the plaintiff underwent thirteen procedures during his first hospital course, including multiple incisions and drainage of the scrotum, breaking up and drainage of pockets of purulent material, debridement, irrigation and packing. During this course, he developed deep venous thrombosis in his leg. He was transferred to a comprehensive nursing facility for pain management and wound care. Shortly thereafter, he was readmitted to the hospital for recurrent scrotal abscess, and underwent four additional surgical procedures. He required extensive home wound care and numerous follow-up appointments with a urologist. A persistent wound fistula developed, which required additional surgical procedures and an eventual fistulotomy.

SPECIAL DAMAGES: The plaintiff incurred medical bills totaling $244,297.35.

SETTLEMENT: The parties agreed to settle for a confidential amount.

PLAINTIFFS’ COUNSEL: Randolph J. Reis, Esquire (Reis Law, PLLC) and Jeanne Trott, Esquire (M. Jeanne Trott, Esq., PLLC)

NAMES/COUNTY: Anonymous v. Anonymous