RESUMO
Perineal gangrene may be classified as primary, e.g. Fournier's gangrene of the external genitals, or secondary due to locoregional injury. Perineal gangrene is still a topic of interest in tropical zones where mortality remains high despite current therapeutic modalities. The purpose of this retrospective study was to analyze etiologic, bacteriologic, and therapeutic data in 30 cases observed over a one-year period in a surgical setting in the Ivory Coast. There were 26 men and 4 women with a mean age of 43 years. All were treated by extensive removal of necrotic tissue in association with antimicrobial therapy for the likeliest agent and appropriate supportive measures. Colostomy was performed in 6 cases and drainage of the urinary tract was required in 11 cases. Anti-tetanus treatment was administered in all cases. Thirteen patients were HIV-positive, five were diabetic, and two presented chronic renal insufficiency. Perineal gangrene was classified as secondary in 17 cases and primary (Fournier's gangrene) in 13 cases. Bacteriologic study of puss and tissue specimens collected from necrotic areas demonstrated a mixed population of microbial organisms predominated by streptococcus A (n = 19) and Escherichia coli (n = 13). Positive diagnostic results were obtained in 5 of 20 hemocultures and in 8 of 11 cystobacteriologic tests. Eight patients died and nine presented complications including necrosis of the testicles, atrophy of the testicles, shock, and coma. Healing was obtained without skin grafting in 22 survival cases but 5 of them required secondary suturing. The mean duration of hospitalization was 45 days. In our experience, perineal gangrene led to severe consequences despite adequate management especially in HIV-infected patients. The treatment of choice is still extensive emergency surgical removal (repeated, if necessary) of necrotic tissue in association with adequate supportive measures and wide spectrum antimicrobial therapy.
