Computerized Tomography of Fournier's Gangrene

Lang, Erich K.; Hanano, Amer; Rudman, Ernest; Macchia, Richard J.

doi:10.1016/j.juro.2009.11.063

Cited by 3 publications

(2 citation statements)

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“…All of the abovementioned factors in association with some bacterial species can easily be the start of a polymicrobial severe subcutaneous infection that begins adjacent to the portal of entry, which may be urethral, rectal or cutaneous (1, 3–18, 26, 29, 32–34, 44). Localized cellulitis progresses to a diffuse inflammatory reaction involving deep fascial planes.…”

Section: Discussionmentioning

confidence: 99%

“…Localized cellulitis progresses to a diffuse inflammatory reaction involving deep fascial planes. This bacterial infection results in microthrombosis of the small cutaneous and subcutaneous vessels leading to the development of gangrene of the overlying skin (1, 3, 5–9, 11–13, 16–18, 26, 29, 32–34, 44). Small subcutaneous vessels thrombosis and subsequent tissue necrosis have as a result low oxygen concentrations which lead to anaerobe growth (5).…”

Section: Discussionmentioning

confidence: 99%

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Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

et al. 2017

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BackgroundFournier’s gangrene (FG) is a rapidly evolving necrotizing fasciitis of the perineum and the genital area, the scrotum as it most commonly affects man in the vast majority of cases. It is polymicrobial in origin, due to the synergistic action of anaerobes and aerobes and has a very high mortality. There are many predisposing factors including diabetes mellitus, alcoholism, immunosuppression, renal, and hepatic disease. The prognosis of the disease depends on a lot of factors including but not limited to patient age, disease extent, and comorbidities. The purpose of the study is to describe the experience of a general surgery department in the management of FG, to present the multimodal and multidisciplinary treatment of the disease, to identify predictors of mortality, and to make general surgeons familiar with the disease.MethodsThe current retrospective study is presenting the experience of our general surgery department in the management of FG during the last 20 years. The clinical presentation and demographics of the patients were recorded. Also we recorded the laboratory data, the comorbidities, the etiology, and microbiology and the therapeutic interventions performed, and we calculated the various severity indexes. Patients were divided to survivors and non-survivors, and all the collected data were statistically analyzed to assess mortality factors using univariate and then multivariate analysis.ResultsIn our series, we treated a total of 24 patients with a mean age 58.9 years including 20 males (83.4%) and 4 females (16.6%). In most patients, a delay between disease onset and seeking of medical help was noted. Comorbidities were present in almost all patients (87.5%). All patients were submitted to extensive surgical debridements and received broad-spectrum antibiotics until microbiological culture results were received. Regarding all the collected data, there was no statistically significant difference between survivors and non-survivors except the presence of malignancy in non-survivors (p = 0.036) and the lower hemoglobin (p < 0.001) and hematocrit (p = 0.002) in non-survivors. However, multivariate analysis did not reveal any predictor of mortality.ConclusionEarly diagnosis, aggressive thorough surgical treatment, and administration of the proper antibiotic treatment comprise the cornerstone for the outcome of this disease. In small populations like in the present study, it is difficult to recognize any predictors of mortality and even the severity indexes, which take into account a lot of data cannot predict mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

et al. 2017

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The emergency computed tomography as important modality for early diagnosis of Fournier gangrene

You

Chung

Kim

et al. 2011

The American Journal of Emergency Medicine

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Management of Fournier's gangrene: a practical guide for clinicians

Hughes,

Bowen,

Saeed

et al. 2023

Br J Hosp Med

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Fournier's gangrene is a localised form of necrotising fasciitis affecting the external genitalia, perineal and perianal regions. Although rare, it is associated with high rates of morbidity and mortality, so clinician awareness is essential for prompt treatment. Risk factors include diabetes mellitus, hypertension, chronic alcoholism and immunosuppression. Perineal pain in patients with sepsis should be treated with a high level of suspicion and early surgical referral is required as prompt debridement can improve outcomes. Repeated surgical intervention and antimicrobial therapy are often needed and recovery can take a long time, with a long-term impact on quality of life. This article discusses the natural history of Fournier's gangrene, aetiology, risk factors, investigations and treatments with an algorithm to support clinical practice.

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Computerized Tomography of Fournier's Gangrene

Cited by 3 publications

References 4 publications

Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

Fournier’s Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis

The emergency computed tomography as important modality for early diagnosis of Fournier gangrene

Management of Fournier's gangrene: a practical guide for clinicians

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