Background: Fournier's disease is a potentially fatal, acute, gangrenous infection of the scrotum, penis or perineum associated with a synergistic bacterial infection of the subcutaneous fat and superficial fascia. Methods: The clinical records of 70 patients treated for Fournier's gangrene were evaluated retrospectively to determine prognostic indices and to stress Fournier's Severity Index (FSI), influencing outcome. Results: The mortality rate in this study was 22.8%. Length of the hospitalization time and FSI were detected as effective factors on mortality of Fournier's gangrene (P < 0.05) by Binary Logistic Regression analysis and the area under the receiver operating characteristic curve of these variables was also found to be significant (P < 0.001). The average FSI was determined as 4.66 -2.31 in survivors and 11.56 -2.68 in non-survivors and 5.11 -2.83 in patients with primary genito-urinary infection but 7.56 -4.35 in primary anorectal infection. The FSI was also found predictive of hospitalization time and number of debridements among survivors. Conclusion: Fournier's Severity Index is a simplified way of comparing patients with this disease and may also have some significance in predicting outcome. The FSI is a more significant and predictive tool that should be popularized to predict the prognosis in Fournier's gangrene.

Presence of perforation is the only predictive factor for maternal morbidity. The aim of the surgeon should be operating the patient before perforation. An observation period may be essential in equivocal patients, but should be individualized according to duration of symptoms and findings of physical examination. The interval between the symptom onset and operation should never exceed 20 hours. Tocolytics should be ordered for the patients with delayed presentation and advanced gestational age in order to prevent preterm labor and fetal loss.

Aggressive preoperative resuscitation, appropriate antibiotic therapy, effective surgery and postoperative metabolic support help minimize morbidity and mortality rates.

Of 306 cases of typhoid enteric perforation, 267 were reviewed retrospectively to determine prognostic indices and therapeutic options influencing outcome. The morbidity and mortality rates were 55.4 and 28.5 percent respectively, and the median duration of hospitalization was 18 days. On the basis of these findings, a prospective series of 39 patients was studied. In the preoperative period, aggressive resuscitation and antibiotic therapy with a combination of chloramphenicol, ampicillin/sulbactam and ornidazole were administered. All patients were given total parenteral nutrition to provide adequate metabolic support in the postoperative period. The morbidity and mortality rates decreased to 25 and 10 percent respectively, and the median hospitalization time was 12 days. The results of this study suggest that aggressive resuscitation and a combined antibiotic regimen in the preoperative period, selected operative procedure and metabolic support decrease the morbidity and mortality of typhoid enteric perforation.

If liquid electrolyte, blood, antibiotics, and parenteral nutrition are applied in typhoid enteric perforation cases adequately, then severe peritonitis becomes an independent risk factor that affects morbidity. Early diagnosis and appropriate surgery type would decrease morbidity and mortality.