Abstract
Objective:To report our experience with Fournier’s Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality.Methods:Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed.Results:Our cases included 8 women and 57 men. The average age of men was 51±13.9 (range 19-75) and the average age of women was 63±10.5 (range 52-76). Average hospitalization time was 9.2±6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement.Conclusions:Fournier’s gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity.
Highlights
Fournier’s gangrene (FG) is a fulminant necrotizing infection of the perianal and periurethral tissues that can disseminate even at the subcutaneous tissue of the thigh or the abdomen following the planes of the dartos fascia of the scrotum and penis, Colle’s fascia and Scarpa’s fascia.[1]
Infectious cases originating from the genitalia, the infecting bacteria probably pass through Buck’s fascia of the penis and spread along the dartos fascia of the scrotum and penis, Colles’ fascia of the perineum, and Scarpa’s fascia of the anterior abdominal wall
A total of 65 patients were identified with FG
Summary
Predisposing factors include advanced age, primary anorectal/genitourinary infections and abscess, low socio-economic status, neurologic deficiency, diabetes mellitus, local trauma, urine leakage, recent perirectal or perineal surgery, periuretral/anal infection, alcohol abuse, immunosuppression.[2,3,4] Patients with poor general health status are prone to FG. This includes malnutrition or obesity, chronic renal failure, chronic liver disease, malignancies and other conditions causing immunosuppression.[5,6]. Wound cultures generally yield multiple organisms, implicating anaerobic-aerobic synergy.[7]
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