Fournier's gangrene: diagnostic approach and therapeutic challenge.

Abstract

To identify the prognostic variables and to assess the role of aggressive management in patients with Fournier's gangrene. Retrospective study. University hospital, Greece. 11 patients (9 men and 2 women) with Fournier's gangrene admitted between April 1986 and December 2000. Early aggressive debridements. Postoperative course, hospital stay, outcome, morbidity, and mortality. The mean age was 65 years (range 17-90) and the mean (SD) duration of hospital stay was 35 (8) days (range 8-62). The aetiology was identified in 8 patients and idiopathic in 3. Predisposing factors (diabetes, n = 4; heart failure, agranulocytosis, and alcohol misuse, n = 1 each) were identified in 6 patients. All patients except one had raised serum glucose concentrations and low serum albumin values. On admission the white cell count was >15 x 10(9)/L in 10, serum sodium <135 mmol/L, mean (SD) serum creatinine 124 (27) micromol/L, and C-reactive protein >150 mg/L was found in all patients. 3/9 male patients required partial excision of the scrotum. Temporary faecal diversion was done for 3 patients. A mean of 3 aggressive repeated debridements (range: 3-6) were required. Nine patients survived and two patients died. Rapid and accurate diagnosis remains the key to achieving a successful outcome. Abnormal laboratory variables on admission may suggest the diagnosis. Early, repeated, aggressive debridement is essential for a successful outcome.