Fournier’s Gangrene: Review of 36 Cases

Abstract

BACKGROUND: Fournier's gangrene (FG) is a very rare disease in daily urological practice. Despite medical improvements, mortality in FG is still high. Early diagnosis is very important to reduce additional instrumentations and mortality. In this study, we aimed to present the characteristics of the patients with Fournier's gangrene followed in two centers during ten years period. METHODS: The medical records of patients with FG were reviewed retrospectively. The patient characteristics, causative pathogens, laboratory findings and treatment modalities were evaluated. RESULTS: A total of 36 FG cases admitted between January 2008 and February 2018 were included in this study, consisting of 35 male patients, and one female patient with a mean age of 59.27±12.91 years. The mean duration of hospital stay was 19±10.44 days. The most common predisposing factor was diabetes mellitus, which was found in 28 patients. Malignancy was detected in three patients; prostate cancer in two patients and chronic lymphoblastic leukemia in one patient. Two patients had liver cirrhosis, and one patient had Behcet's disease and psoriasis. The microbiological agent was isolated from a wound culture in nine patients. After urgent surgical debridement, daily dressing with nitrofurazone (Furacin) was done. Additional debridement was conducted when necessary. Orchiectomy was performed in 10 patients; two of them underwent bilateral orchiectomy. One patient died because of sepsis on the seventh day of hospital admission. CONCLUSION: FG is a life-threatening urological emergency with a high mortality rate. Treatment with broad-spectrum antibiotics and urgent surgery is pivotal for the prevention of mortality.

Fournier’s Gangrene: Management in a Poor Resource Setting

“…Although only 18% required transfusion in a study by Benjelloun, more than half of our patients required blood transfusion [11]. Renal impairment occurred in about onethird of patients compared to what was reported in a recent study by Caliskan et al [12] The organism most commonly identified in this study was E. coli, similar to the findings of other studies [8,13].…”

“…None of our patients had their testis removed in contrast to the findings of some recent studies [12,15]. This is because the testes derive their blood supply from the gonadal artery a branch of the aorta whereas the scrotal and penile skin obtain their arterial supply from the internal and external pudendal arteries [1].…”

Scoring Systems for the Prediction of Mortality in Patient with Fournier’s Gangrene: an Analysis of 60 Patients

“…In most of the previously published studies, the presence of DM in patients with FG has been shown as one of the major prognostic factors for morbidity and mortality [1,16,[20][21][22]. Nevertheless, some researchers did not report significant associations between DM and FG [2,3,19].…”

A rare case of male Fournier’s gangrene with mixed Actinomyces turicensis infection

“…Then bacterial spread causes obliterative endarteritis, resulting in aggressive ischaemic necrosis of the fascia, and the affected areas turn into ulceration skin gangrene with sensory loss after 3-8 days, or even bacteraemia and septic shock in severe cases [4]. The most common pathogen of FG is polymicrobial organisms involving mixed aerobes and anaerobes, followed by Escherichia coli and Streptococcus [5,6]. Here, we report a rare case of FG mixed with A. turicensis infection.…”