Fournier’s Gangrene: Clinical Presentation of 13 Cases

Abstract

BackgroundFournier’s gangrene (FG) is a fulminant form of infective, polymicrobial, necrotizing fasciitis of the perineal, genital, and perianal regions. It commonly affects men, but women and children may also develop this type of tissue necrosis.Material/MethodsThis study is a retrospective analysis of the management of 13 cases of Fournier’s gangrene, diagnosed from among about 45 000 patients (men, women, and children) treated in the Department of General, Oncological, and Functional Urology (Medical University of Warsaw) from 1995 to 2013. All patients with Fournier’s gangrene underwent adequate surgical debridement of the necrotic tissues. Additional procedures (suprapubic cystostomy and orchiectomy) were necessary in 10 out of 13 (77.0%) patients. Seven out of 13 (53.8%) patients required subsequent reconstructive surgery of the scrotum.ResultsAll 13 patients were males, with a median age of 59.6 years (range: 42–68 years). The average hospital stay was 31.9 days (range: 16–46 days). None of our patients died due to Fournier’s gangrene. Bacteriological cultures of samples from the wounds showed polymicrobial flora, including the following genera of aerobes and anaerobes: Escherichia, Proteus, Klebsiella, Moraxella, Gemella, Enterococcus, Streptococcus, Staphylococcus, Bacteroides, Pseudoflavonifractor, Parabacteroides, Porphyromonas, Prevotella, Peptoniphilus, Peptostreptococcus, Actinomyces, Collinsella, and Lactobacillus.ConclusionsFavorable outcome of FG treatment with low morbidity and no mortality can be achieved with rapid diagnosis, urgent surgical debridement of all necrotic tissues, and broad-spectrum empirical antimicrobial therapy, usually with combined antibiotics, against aerobic and anaerobic bacteria. Prevention of uroseptic shock by treating localized infection is compulsory.

Fournier’s Gangrene: Review of 36 Cases

“…[13] The differential diagnosis includes many diseases, such as cellulitis, acute epididymitis, orchitis, strangulated hernia, scrotal abscess, balanitis, herpes infection, pyoderma gangrenosum, polyarteritis nodosa, warfarin necrosis and ecthyma gangrenosum. [6] Radiological examinations, such as X-rays, ultrasonography, computed tomography and magnetic resonance imaging techniques, may be helpful in the diagnosis when the diagnosis is uncertain. [12] The ultrasonographic finding is thickened scrotal tissue due to inflammation and edema.…”

“…There are some predisposing factors for FG, such as diabetes mellitus, alcoholism, atherosclerosis, peripheral arterial disease, trauma, tissue injury, malnutrition, immunosuppression, HIV infection, liver disease and leukemia. [6] These predispos-…”

Impact of radiological diagnostics in the survivor of disseminated Fournier gangrene patient with septic pulmonary embolism

“…Perianal abscess is the most common out of many other iatrogenic, infective and malignant anorectal causes. The urological inciting factors could be from urethral instrumentation/catheterisation, prostatic biopsies, urinary bladder carcinoma, perineal/ pelvic surgery, genitourinary infections, urinary extravasation and local trauma 10 11…”

Fournier’s Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature

“…In two patients with malignancy-induced FG, the tissue was not sent for histopathologic analysis. The diagnosis and treatment of the underlying neoplasm were delayed for over one year and was associated with worse overall survival [20].…”