Clinical Analysis of Fournier's Gangrene Caused by a Perianal Abscess

ABSTRACT

PURPOSE: Fournier's gangrene is a rapidly progressive fulminant infection of the perineum and abdominal wall along with the scrotum in men and the vulva in women. If the effective surgical treatment is delayed, the patients result in fatal. Modern surgical series report a mortality of 8-67%. Objective: The aims of this study were to examine the outcomes of 20 consecutive patients with Fournier's gangrene caused by a perianal abscess and to identify the factors leading to improved survival in these patients. METHODS: The medical records of all patients who had been treated at Chosun University Hospital between January 1991 and December 1999 for Fournier's gangrene caused by a perianal abscess were retrospectively reviewed. RESULTS: Twenty patients were identified (mean age 47 years, range 20-66). The sexual ratio was 2.31 (malefemale). The etiologies included perianal fistula (35%), unknown (35%), hemorrhoidectomy (10%), rectal cancer perforation (10%), and injection therapy (10%). Associated conditions included diabetes mellitus (50%), liver cirrhosis (10%), pulmonary tuberculosis (5%), intestinal tuberculosis (5%), ulcerative colitis (5%), Crohn's disease (5%) and iron deficiency anemia (5%). Escherichia coli and bacteroid fragilis were most commonly identified. All 20 patients initially received multiple incisions and debridement. At the time of first surgery, a diverting colostomy was required in 35% of the cases and a ileostomy in 5%. Over the past 10 years, the survival rate of patients with Fournier's gangrene caused from perianal abscess has been high (100%). CONCLUSION: The keys to a successful outcome included early diagnosis, prompt surgical intervention with radical debridement, prompt fluid resuscitation, rapid initiation of broad-spectrum antibiotics, and hemodynamic support in an intensive care setting.