Fournier's gangrene by perianal abscess / Gangrena de Fournier por abscesso perianal

ABSTRACT Objective: To describe and analyze the cases of Fournier's Gangrene caused by perianal abscess treated in a tertiary hospital in western Paraná, correlating possible factors that influence mortality, with emphasis on late diagnosis and therapy. Methods: A retrospective and descriptive case series was carried out based on the analysis of medical records of patients with Fournier's Gangrene due to perianal abscess from January 2012 to December 2017. Results: Thirty-one patients with Fournier's Gangrene due to perianal abscess were treated in the period: 26 men and 5 women. Mean age was 53.51 ± 14.5 years. The most prevalent comorbidity in this group was type 2 diabetes mellitus, showing a strong correlation with mortality. The mean time from disease progression, from the initial symptom to the admission at the service, was 9.6 ± 6.81 days. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 3.25 ± 2.89 procedures/patient. Seven (22.58%) patients died and all of them showed signs of sepsis on admission; only 2 patients with sepsis did not die. Conclusion: The presence of sepsis on admission and type 2 diabetes mellitus were strongly correlated with mortality.

RESUMO Objetivo: Descrever e analisar os casos de gangrena de Fournier por abscesso perianal atendidos em hospital terciário do oeste do Paraná, correlacionando possíveis fatores que influenciem a mortalidade, com ênfase ao diagnóstico e terapêuticas tardias. Métodos: Realizou-se um estudo de série de casos, retrospectivo e descritivo baseado na análise de prontuários de pacientes portadores de gangrena de Fournier devido a abscesso perianal no período de Janeiro de 2012 à Dezembro de 2017. Resultados: Foram tratados 31 pacientes com gangrena de Fournier por abscesso perianal no período, sendo 26 homens e 5 mulheres. A média de idade foi de 53,51 ± 14,5 anos. A comorbidade de maior prevalência neste grupo foi diabete melitus tipo 2, demonstrando forte correlação com mortalidade. A média do tempo de evolução da doença, do sintoma inicial até entrada no serviço, foi de 9,6 ± 6,81 dias. Todos os pacientes foram submetidos à antibioticoterapia e tratamento cirúrgico com média de 3,25 ± 2,89 procedimentos/paciente. Sete (22,58%) pacientes evoluíram para óbito e todos estes apresentavam sinais de sepse na admissão; apenas 2 pacientes com sepse não evoluíram a óbito. Conclusão: Presença de sepse a admissão e diabete melitus tipo 2 foram fortemente correlacionadas com mortalidade.

Profile of patients with Fournier's gangrene and their clinical evolution / Perfil dos pacientes com gangrena de Fournier e sua evolução clínica

ABSTRACT Objective: to analyze the profile of patients with Fournier's gangrene treated in a public tertiary hospital in western Paraná State. Methods: we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier's gangrene treated between January 2012 and November 2016. Results: there were 40 patients with Fournier's gangrene treated in the period, 29 (72.5%) men and 11 (27.5%) women. The mean age was 51.7±16.3 years. The mean time of disease progression, from the initial symptom to hospitalization, was 10.5±1.2 days. All patients had clinical signs such as pain, bulging, erythema, among others, and 38 (95%) had associated comorbidities, the most common being type 2 diabetes mellitus and systemic arterial hypertension. The majority (30 patients - 75%) had perianal abscess as the probable etiology. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 1.8±1.1 surgeries per patient. Nine (22.5%) patients died. There was a strong correlation between the presence of sepsis on admission and mortality. Conclusion: Fournier's gangrene patients in this series had a long disease duration and a high prevalence of comorbidities, with a high mortality rate.

ABSTRACT Objetivo: analisar o perfil dos pacientes com gangrena de Fournier tratados em um hospital público terciário do oeste do Paraná. Métodos: estudo transversal, retrospectivo e descritivo de pacientes portadores de gangrena de Fournier atendidos no período de janeiro de 2012 a novembro de 2016. Resultados: foram tratados 40 pacientes com gangrena de Fournier no período: 29 (72,5%) homens e 11 (27,5%) mulheres. A média de idade foi de 51,7±16,3 anos. A média de tempo de evolução da doença, do sintoma inicial até a internação, foi de 10,5±1,2 dias. Todos os pacientes apresentaram algum sinal clínico como dor, abaulamento, eritema, entre outros, e 38 (95%) tinham comorbidades associadas, sendo as mais comuns diabetes mellitus tipo 2 e hipertensão arterial sistêmica. A maioria (30 pacientes -75%) apresentava como etiologia provável abscesso perianal. Todos os pacientes foram submetidos à antibioticoterapia e tratamento cirúrgico com média de 1,8±1,1 cirurgias por paciente. Nove (22,5%) pacientes morreram. Houve forte correlação entre a presença de sepse na admissão e mortalidade. Conclusão: pacientes portadores de gangrena de Fournier, nesta casuística, apresentavam longo tempo de doença e elevada prevalência de comorbidades com alto índice de mortalidade.

Fournier's gangrene - case report and a brief review

Fournier's gangrene is a serious condition with very high mortality. It is usually associated with various co-morbidities. Early diagnosis with multispecialty approach and aggressive management is the key to successful outcome. We successfully managed Fournier's gangrene in a 32-year-old diabetic male. This case is reported and the condition is reviewed in the light of recent literature

Fascitis necrotizante perineal: Gangrena de Fournier / Perineal necrotizing fasciitis: Fournier's gangrene

La gangrena de Fournier o fascitis necrotizante perineal es una entidad infecciosa que afecta las fascias perineales y/o sus dependencias. Es prevalente en hombres de la 5ta o 6tadécada de su vida, y es más común en diabéticos, obesos, enolistas o inmunodeprimidos. El sostén metabólico, la antibioticoterapia, eldebridamiento de tejidos necróticos y la reparación de tejidos son los pilares del tratamiento. Reporte de casos: En el presente artículo presentamos unarevisión bibliográfica de esta enfermedad, y presentamos 3 casos dediferente resolución en nuestro hospital, a modo de ejemplo, con susrespectivos registros fotográficos. Discusión: La fascitis necrotizante perineal es una grave entidad infecciosa que requiere diagnóstico temprano, tratamiento oportuno multidisciplinario y reconstrucción de tejidos según el caso, para lo cual existen varias opciones...

Fournier's gangrene or perineal necrotizing fasciitis is an infectious entity affecting perineal fascias and / or its dependencies. It is more prevalent in men in the 5th or 6thdecade of life and is more common in diabetics, obese, alcoholics or immunodeppressed. Metabolic support, antibiotic therapy, debridement of necrotic tissue and tissue repair arethekey of treatment. Cases Report: In this article we present a literature review of the disease and present 3 cases of different resolution in ourhospital, as examples, with their photographic records. Discussion: The perineal necrotizing fasciitis is aseriousinfectious entity that requires early diagnosis, early multidisciplinary treatment and tissue reconstruction according to case, for which there are several options...

Avicenna's canon of medicine and modern urology part II: bladder calculi

In the previous issue of the Urology journal, a comparison of Avicenna's Canon of Medicine with modern urologic findings was done in part I of this article, addressing bladder anatomy and physiology and bladder calculi. In part II of this review, the remaining chapters of the Canon of Medicine on bladder calculi are reviewed. Avicenna points to perineal urethrostomy [perineostomy], which is today performed as the last therapeutic line or as a temporary remedy before surgical treatment. He also describes surgery via transperineal route and warns the surgeon of the proximity of vasa deferentia, prostate gland, and neurovascular bundle and their exposure in this position. Usage of grasping forceps for removal of bladder calculus and emphasis on removing all calculus fragments are the interesting points of this chapter. Avicenna explains a technique similar to the use of a Babcock forceps for prevention of calculus migration. Complications of bladder calculus surgery and cystotomy are also addressed with scientific precision in the Canon. It is noteworthy that 8 centuries before Fournier described necrotizing fasciitis in male genitalia, Avicenna had described Fournier gangrene in his book

Fournier's gangrene: evaluation of 68 patients and analysis of prognostic variables.

CONTEXT: Fournier's gangrene (FG) is a rapidly progressing acute gangrenous infection of the anorectal and urogenital area. AIMS: The objectives of this study were to investigate patients with FG and to determine risk factors that affect mortality. SETTINGS AND DESIGN: Retrospective clinical study. MATERIALS AND METHODS: Clinical presentations and outcomes of surgical treatments were evaluated in 68 patients with FG. Statistical Analysis Used: Chi-square, Student's t -test, and logistic regression test. RESULTS: Mean age of patients was 54 and female-to-male ratio was 9:59. Among the predisposing factors, diabetes mellitus (DM) was the most common ( n =24, 35.3%), and sepsis on admission was detected in 31 (45.6%) and 15 (22.1%) patients, respectively. Seven (10.3%) patients died. Using logistic regression test, Fournier's Gangrene Severity Index (FGSI)> 9, DM and sepsis on admission were found as prognostic factors. CONCLUSIONS: FG has a high mortality rate, especially in patients with DM and sepsis. An FGSI value> 9 indicates high mortality rate.

Reconstrução peno-escrotal após Síndrome de Fournier / Penil scrotal reconstruction after Fournier’s Gangrene

A reconstrução do escroto, com adeqüada proteção dos testículos, representa um desafio após síndrome de Fournier. Os autores relatam o caso, de um paciente de 20 anos, apresentando lesão extensa acometendo escroto e pênis, devido a síndrome de Fournier. O tratamento do pênis consistiu de enxerto de pele, disposto de forma helicoidal, para evitar retrações. O escroto foi reconstruído utilizando-se um retalho fasciocutâneo de região supéro-medial da coxa, de pedículo inferior, 43 dias após o primeiro desbridamento. O resultado mostrou-se satisfatório, funcional e esteticamante, apesar do tratamento não estar finalizado.

Scrotal reconstruction with adequate protection of the testicles remains the challenge following Fournier’s gangrene. The author report on a 20-years-old man presented with an extensive defect of the scrotum and penile caused by Fournier’s gangrene. The penile coverage was gained by grafts helicoidally placed to avoid retractions. The scrotum was reconstructed using a fasciocutaneous supermedial thigh inferiored based flap, 43 days after the first debridement.The results were satisfactory both functionally and cosmetically, although the treatment is not complete.

Gangrena de Fournier / Fournierïs gangrene

Se analiza la experiencia en el manejo de 11 pacientes atendidos por gangrena de Fournier en el período 1992-1997 en nuestro servicio. El origen de la gangrena fue por absceso anorrectal en un 73 por ciento y uropatía obstructiva en un 18 por ciento. De los 8 pacientes con absceso anorrectal, 4 habían sido drenados antes de la presentación de la gangrena, siendo todos ellos diabéticos. El 81 por ciento de los pacientes presentaba al menos una patología asociada predisponente, siendo la diabetes la más habitual. Se rescataron cultivos de herida operatoria en 9 pacientes siendo todos positivos para aerobios y 5 para anaerobios. Se realizó aseo quirúrgico en 10 pacientes, practicándose colostomía en 3 pacientes y cistostomía en 2. Un paciente recibio 10 sesiones de terapia con oxígeno hiperbárico (OHB), evolucionando sin complicaciones. Fallecieron 3 pacientes (27 por ciento), todos por falla orgánica múltiple. La gangrena de Fournier es aún una patología de alta mortalidad. Se requiere un drenaje amplio y precoz de los abscesos anorrectales especialmente en pacientes diabéticos, o con algún otro factor predisponente, ya que son éstos los que generalmente llegan a la gangrena. El manejo o apoyo de estos pacientes por cirujanos con experiencia en su tratamiento es fundamental

Factores pronósticos en las infecciones severas del periné / Prognosis factors in severe infections of perineum

Se evaluaron los factores de riesgo en las infecciones severas del periné en 20 pacientes atendidos entre enero de 1984 y diciembre de 1995 en la Clínica Modelo de Lanús. Entre los múltiples factores evaluados al ingreso, consideramos como desfavorables: la diabetes, la edad avanzada, neoplasias, el tiempo de evolución de la enfermedad y la puntuación APACHE II mayor 30 puntos. En la evolución de la enfermedad consideramos que la sepsis, la progresión anatómica de la infección y el número de cirugías inciden desfavorablemente, aumentando el índice de mortalidad. Se concluye que la estadificación clínica de estos enfermos, la detección temprana de las complicaciones sistémicas, y el acto quirúrgico efectivo son los aspectos fundamentales que llevaran a obtener una menor morbimortalidad.

Infección necrotizante perineal (gangrena de Fournier) / Necrotizing perineal infection (Fournier's gangrene) in the newborn

La gangrena de Fournier es una afección muy grave, poco descripta en pediatría y menos aún en el período neonatal. Compromete la vida del paciente y provoca graves lesiones en los tejidos blandos del periné con gran destrucción tisular y de los tejidos afectados. Para evitar la frecuente evolución letal de esta enfermedad es fundamental el diagnóstico rápido, la obtención de cultivos para efectuar un tratamiento quirúrgico precoz y radical de las lesiones y la eventual colostomía cuando se afecte el esfínter anal