Extramammary Paget Disease Of Perineum With A Postoperative Complication Of Acute Kidney Injury:a Case Report And Literature Review

OBJECTIVE:To review the experience in the diagnosis and treatment of extramammary Paget disease and acute kidney injury and analyze the clinical characteristics.METHODS:We present one case of extramammary Paget disease who was performed a wide local excision. But he had a postoperative complication of acute kidney injury. His medical records were analyzed retrospectively and the literature was reviewed.DESIGN:Case report.PATIENT:A 64-year-old man presented with a ulcerated eczematous red lesion on the penoscrotum and his right groin for more than 15 years. The lesion had a clear boundary, about 9cm X 8cm, with non-contiguous erosion and faint yellow exudate and covered by some crust. None of the bilateral inguinal lymph node was palpable. All the preoperative exam did not reveal any abnormalities. The patient then underwent wide local excision and immediate reconstruction with a split-thickness skin graft.3 days after the operation the patient appear less urine, abdominal distension, accompany with the continuing increase of BUN and Scr. Besides, the patient was suffering from wound infection later.INTERVENTIONS:The patient was given hematodialysis and the combined supporting treatment which included anti-infection, diuretics, correction of anemia and hypoproteinemia, nutrition support. The wound was given regular dressing change and red light therapy to control the infection.RESULTS:After effective therapies, the patient’s clinical symptoms disappeared, and his urine routine and renal function could recover. Most of the grafted skin was healing by second intention.CONCLUSIONS:Extramammary Paget disease is a special malignant skin tumor condition of apocrine gland-bearing skin. There is a high incidence of associated invasive disease. It is easy to misdiagnose for lack specific clinical manifestation. Its diagnosis should be confirmed with pathological examination and immunohistochemical staining. It is generally accepted that surgical procedures are the standard modality of treatment. In order to prevent the serious complications, strict fluid management is very important for the elderly. Besides, the condition of blood pressure, renal function, urine volume and so on, should be monitored. Renal toxicity drugs should be used with caution. Acute kidney injury is a serious complication during perioperative period. The treatment of acute renal failure hinges on identification and treatment of the underlying cause. The early renal replacement therapy and efficient support treatment are very important measures to critical patients.