Fournier’s Gangrene- Presentation and Outcome.

ABSTRACT

Background: Fournier’s gangrene (FG) is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children factors associated with the mortality rate among patients admitted with clinical diagnosis of FG have been described in this study. Materials and Methods: This study was conducted in the Department of Surgery, JSS Medical College and Hospital from September 2014 to September 2016 on 30 patients admitted with a clinical diagnosis of FG over a period of 2-year. Data on demographics, clinical history and physical examination, vital signs, and laboratory values on admission were recorded on a designed data collection sheet. The patients were stratified according to factors associated with mortality using Chi-squared and independent t-test. Results: The disease-related hospital mortality rate was 13.3% (4/30). The median hospital stay was 15 days. The median age of the 30 patients was 45 years. The patients that did not survive were significantly older than those that survived (48.5 ± 15.15 vs. 45.3 ± 13.17 years) (P = 0.7). Diabetes mellitus (DM) was the most common risk factor accounting for 93.3% of the cases. Ischemic heart disease (IHD) at presentation was significantly associated with mortality with a rate of 50% among patients. The urogenital tract source of infection was associated with increased mortality (P = 0.4). Escherichia coli and Staphylococcus aureus were the most common pathogens isolated. The number of debridement did not differ significantly between survivors and nonsurvivors. Abdominal involvement was also significantly associated with higher mortality. There was no factor that was independently associated with mortality after multiple logistic regression analysis. Conclusion: FG remains a potentially fatal condition in our environment with a mortality rate of 13.3%. On univariate analysis, an older age, presence of IHD on admission, a urogenital source of infection, severe sepsis, and abdominal involvement are associated with mortality in our environment. The presence of DM, delay in presentation, and number of surgical debridement does not seem to affect mortality in our environment.