Fournier's gangrene: outcome analysis and prognostic factors

Background: Fournier's gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes.Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier's gangrene. Methods: A prospective hospital based observational study on 51patients with a clinical diagnosis of Fournier's gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival.Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin(p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival.Conclusion: Fournier's gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction

Fournier's Gangrene Secondary to Appendicectomy

Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the scrotum. Case report: A 33-year-old male presented in the accident and Emergency department of Living Word Mission Hospital with a few days history of painful scrotum with desquamation of the epithelium of the scrotal skin. He gave a history of an appendicectomy for a ruptured appendix carried out 8 days earlier at another hospital. Examination revealed a dehisced appendicectomy wound and a de-epithelialized distal scrotal skin. A diagnosis of Fournier's gangrene was made. He was commenced on potent antibiotics and had debridement of the scrotal wound. The wound improved with healthy granulation tissue and it was then covered with a split skin graft. Lesson: When the appendix is found to be ruptured at operation; potent antibiotics are required to forestall the spread of the infection in the peritoneum or along the fascial planes causing necrotising fasciitis

Fournier's gangrene secondary to appendicectomy

Background: Fournier's gangrene is predominantly an infectious process involving the superficial and deep fascial planes in the perineal area. Aim: To highlight the existence of a potential space between the Scarpa's and Camper's fascia which allows for spread of infection from an infected appendicectomy wound to the scrotum. Case report: A 33-year-old male presented in the Accident and Emergency department of Living Word Mission Hospital with a few days history of painful scrotum with desquamation of the epithelium of the scrotal skin. He gave a history of an appendicectomy for a ruptured appendix carried out 8 days earlier at another hospital. Examination revealed a dehisced appendicectomy wound and a de-epithelialized distal scrotal skin. A diagnosis of Fournier's gangrene was made. He was commenced on potent antibiotics and had debridement of the scrotal wound. The wound improved with healthy granulation tissue and it was then covered with a split skin graft. Lesson: When the appendix is found to be ruptured at operation; potent antibiotics are required to forestall the spread of the infection in the peritoneum or along the fascial planes causing necrotising fasciitis

La gangrene perineale a propos de 78 observations

Objectives: To describe the epidemiologic; diagnostic and therapeutic aspects of Fournier's gangrene. Patients and Methods: This retrospective study was carried out on 78 patients (77 males and 1 female) treated for Fournier's gangrene at the University Hospital of Treichville; Abidjan; Cote d'Ivoire; between January 1998 and October 2004. The patients' mean age was 43.3 years (range: 10 - 80 years). Results: The median time elapsed between onset of the infection and consultation was 18 days. A port of entry and predisposing factors could be identified in 43 and 42 patients; respectively. The diagnosis was based on clinical examination. Escherichia coli and Enterobacter aeruginosa were the predominant microbial organisms isolated. Twenty-two patients had to be admitted for intravenous alimentation. All patients were treated by antibiotherapy; excision of necrotic tissues and subsequent wound dressing. Colostomy and cystostomy were performed in 14 patients each. Orchidectomy and penectomy were necessary in 5 and 3 patients; respectively. Healing was achieved without skin graft in 36 patients; while secondary suturing; skin graft and muscle flap were necessary in 18; 6 and 4 patients; respectively. Fourteen patients died from septic shock giving a mortality rate of 17.9. Delayed consultation; shock and predisposing factors such as diabetes mellitus gave a poor prognosis. Conclusion: An early diagnosis; stabilization of the patient's hemodynamic status and debridement of the whole necrotic tissue combined with antibiotherapy will certainly reduce the risk of mortality in patients with Fournier's gangrene