ABSTRACT
La gangrena de Fournier es una condición grave que se presenta mayormente en varones a raíz de lesiones infecciosas perineales y en pacientes con factores de riesgo predisponentes. Los gérmenes implicados son bacilos gram negativos, cocos gram positivos y anaerobios, comensales de la zona perineal. El diagnóstico es clínico, encontrando desde lesiones eritematosas hasta necrosis junto con crepitación, y se confirma con pruebas de imagen, principalmente TC que es la prueba de referencia y nos muestra la extensión de la lesión. El pronóstico de supervivencia se calcula con el índice de severidad de la gangrena de Fournier que incluye parámetros analíticos y funcionales. El manejo consiste en tratamiento médico con antibióticos y desbridamiento quirúrgico urgente de las lesiones necróticas. Luego de la fase aguda se puede realizar cirugía reconstructiva de las zonas desbridadas con posterior rehabilitación para recuperación de la función. Entre otras opciones terapéuticas encontramos el cierre asistido por vacío, la aplicación de miel y la oxigenoterapia hiperbárica (AU)
Fournier's gangrene is a serious condition that occurs mostly in males following perineal infectious lesions and in patients with predisposing risk factors. Germs involved are gramnegative bacilli, positive cocci and anaerobes, located on perineum. The diagnosis is clinical, from erythematous lesions to necrosis with crepitus. Diagnosis is confirmed mainly with CT and shows the extent of the injury. The prognosis for survival is calculated using the Severity Index Fournier's gangrene which includes analytical and functional parameters. Management is medical treatment with antibiotics that requires emergency surgical debridement of necrotic lesions. After the acute phase can be performed reconstructive surgery of debrided areas with subsequent rehabilitation for functional recovery. Other therapeutic options are the vacuum-assisted closure, application of honey and hyperbaric oxygen therapy (AU)
Subject(s)
Humans , Male , Fournier Gangrene/complications , Fournier Gangrene/diagnosis , Fournier Gangrene/surgery , Diabetes Mellitus/diagnosis , Fournier Gangrene/prevention & control , Fournier Gangrene/psychology , Fournier Gangrene/rehabilitation , Fournier Gangrene/therapy , Diabetes Mellitus/therapySubject(s)
Catheters, Indwelling/adverse effects , Homes for the Aged , Nursing Homes , Urinary Catheterization/adverse effects , Urinary Tract Infections/etiology , Aged, 80 and over , Catheters, Indwelling/microbiology , Fournier Gangrene/etiology , Fournier Gangrene/prevention & control , Humans , Male , Physical Therapy Modalities , Stroke Rehabilitation , Urinary Catheterization/instrumentation , Urinary Incontinence/rehabilitation , Urinary Tract Infections/prevention & controlABSTRACT
BACKGROUND: The aim of this study was to evaluate the necessity of preventive colostomy for Fournier's gangrene of the anorectal region. METHODS: The medical records of 37 patients with perianal Fournier's gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was performed in 19 patients (Group D&HC). RESULTS: There were no statistically significant differences between the D and D&HC groups with respect to mean age (p=0.73), sex ratio (p=1.00), diabetes mellitus (p=0.88), concomitant diseases (p=0.57), and number of debridements (p=0.75). The medical and surgical complication and mortality rates and duration of hospital and intensive care unit stays were also not significantly different between the D and D&HC groups (p>0.05). Fecal diversion was done at the initial operation in 11 patients, at second operation in 6 patients, and at third operation in 2 patients. When compared, morbidity rates were similar, but mortality rates were statistically different (p=0.031). CONCLUSION: Fournier's gangrene remains a difficult surgical problem. Despite aggressive multidisciplinary treatment, it still has a high mortality rate. Fecal diversion in the treatment of Fournier's gangrene is controversial. If necessary, preventive colostomy should be performed during the initial debridement.
Subject(s)
Anus Diseases/surgery , Colostomy , Fournier Gangrene/prevention & control , Fournier Gangrene/surgery , Rectal Diseases/surgery , Adult , Aged , Anus Diseases/mortality , Anus Diseases/prevention & control , Debridement , Female , Fournier Gangrene/mortality , Humans , Male , Middle Aged , Rectal Diseases/mortality , Rectal Diseases/prevention & control , Retrospective Studies , Treatment OutcomeABSTRACT
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