Perforated Rectal Cancer Presenting as Fournier's Gangrene in a Confused Older Patient

We present the case of an eighty-two-year-old man who presented with testicular pain, diarrhoea, fresh rectal bleeding, and weight loss. A clear history was not obtained because of presumed chronic confusion secondary to age related vascular dementia. He was subsequently diagnosed with Fournier's gangrene and a retrospective obtainment of his collateral history revealed a completely normal pre-morbid cognitive level of function. Thus, his confusion was secondary to an atypical cause of sepsis and he was managed with surgical debridement. We highlight the value of urgent computed tomography (CT) scanning as well as the use of screening tools for assessing cognitive function, particularly in surgical specialties, as well as the importance of obtaining a collateral history and discussing means for better collaborative efforts amongst surgeons and physicians in managing the "confused patient".