Fournier’s Gangrene: Literature Review and Clinical Cases

Abstract

Background: Fornier gangrene is an extremely rare disease of the genitals. This disease is a result of the urogenital tract, anorectal area, and genital skin infections, appearing usually in immunocompromised patients with diabetes, obesity, and malignant neoplasms. The basic treatment of Fournier gangrene includes an emergency surgical intervention combined with antibiotic therapy and detoxification. Methods: A review of recent papers comprising studies and reviews published in 2005–2016 was performed. The clinical cases were studied at the Department of Purulent Surgery Central Clinical Hospital No. 1, where 7 patients were diagnosed and treated. Results: The etiology, pathogenesis, clinical and laboratory presentation, diagnosis, treatment, and prognosis of Fournier gangrene are described in this article. The authors have described several clinical cases of patients with Fournier gangrene and with necrotic cellulitis and fasciomyositis of anterior abdominal wall, which is a manifestation of Fournier gangrene. Making allowance for the unfavorable epidemiological situation of syphilis in Russia, the increase in the incidence of complicated, atypical chancre, and therefore, the need for differentiation of Fournier gangrene with such manifestations of syphilis as necrotizing, esthiomenous chancre, indurative edema, the appropriate clinical examples are well explained in this article.

Fournier’s Gangrene: Five Years’ Experience from a Single Center in Turkey

“…Fournier's gangrene is known to be a rapid onset disease, but studies have shown that application to the hospital is delayed by an average of one week after initial symptoms have presented. [13] In our study, the median time from symptom onset to hospital application was four (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days. Immediate diagnosis and treatment of FG are known to affect prognosis.…”

“…The age of the patients hospitalized in the intensive care unit (ICU) was found to be higher than the patients who did not require ICU admittance (65.33±11.63 years vs. 54.39±11.79 years, respectively; p=0.013). Median FGSI score was 2 (0-14), while the median UFGSI score was 4 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Median FGSI and UFGSI scores were found to be higher in patients accepted to the ICU compared to those who were not (4 vs. 2, p=0.025; and 6 vs. 3, p=0.002, respectively).…”

“…Predisposing factors are a long list, including diabetes mellitus, alcoholism, atherosclerosis, peripheral arterial disease, Raynaud's phenomenon, malnutrition, immunosuppression (e.g., chemotherapy, steroids, and malignancy), HIV infection, leukemia and liver diseases. [1,2] Necrosis of the tissues in the affected area, pain, and tenderness are the most common symptoms. Although a definite tensive care unit.…”

“…We constructed this study on three different research questions as follows: (1) Were the treatment characteristics of patients with and without DM different? (2) Were the clinical and treatment characteristics of patients with or without ICU admittance different? (3) Were clinical and treatment characteristics of patients with and without recurrence changed?…”

Predicting Mortality in Fournier Gangrene and Validating the Fournier Gangrene Severity Index: Our Experience with 50 Patients in a Tertiary Care Center in India

“…However, Ulug et al [16] and Luján Marco et al [13] did not find any significant association between the day of presentation to the hospital and mortality. Chernyadyev et al [32] also noted that manifestations of venereal diseases should be differentiated from the initial features of FG so as to prevent development of fulminant disease.…”