Fournier's syndrome of urogenital and anorectal origin a retrospective, comparative study

Abstract

Twenty-eight patients with genital and perianal necrotizing infections are described. The patients were divided into three groups according to the primary site of infection: group 1, anorectal (14 patients); group 2, urologic (ten patients), and group 3, idiopathic (four patients). The overall mortality was 25 percent, 28.5 percent for the anorectal group and 10 percent for the urologic group, although this difference is not statistically significant. Necrotizing infections of anorectal origin were more severe and had a less typical way of presentation, with subsequent delay in diagnosis and a higher rate of myonecrosis. As a consequence, more debridements and more fecal derivations had to be performed. The etiologic agents were the same among the three groups and comprised a number of anaerobes (Bacteroides spp, gram-positive cocci) as well as aerobes (microorganisms belonging to the Enterobacteriaceae and S. faecalis). Necrotizing fasciitis was the pathologic picture of nine of ten patients with Fournier's gangrene of urogenital origin and seven of 14 with an anorectal source. Synergistic necrotizing cellulitis was identified in half of those secondary to anorectal origin and only one of those with a urologic source.

Overview of different scoring systems in Fournier’s Gangrene and assessment of prognostic factors

“…[2,3,10,15,16] In general, factors related to disease and host are important prognostic factors. These factors include an anorectal source, advanced age, extensive disease (involving abdominal wall or thighs), shock or sepsis, renal failure, and hepatic dysfunction.…”

“…[4,15,17] DM was the most common comorbidity associated with FG, and it was present in 50% (24-72%) of the patients at the time of admission. [2,7,8,10,[19][20][21][22] Tissue ischemia resulting from the involvement of small vessels has been accounted for increased tendency of diabetics to FG.…”

Factors affecting the number of debridements in Fournier's gangrene: our results in 36 cases

“…[7] It may result from various etiological origins; however, its course may be more mortal when developed from an anorectal origin than with urogenital origin. [8][9][10][11] Our series did not include any patient with anorectal origin.…”

Necrotizing Fasciitis of the Perineum and the Abdominal Wall-Surgical Approach

“…However, it has to be defined more precisely what surgical debridement means in these cases of foudroyant and rapidly spreading soft tissue infections. The goal of initial and immediate surgery is to remove all non-viable tissue, and to stop thereby the progression of the infection and alleviate systemic toxicity [31,32]. The margins of the incision should always be situated in macroscopically healthy tissue, performing an anatomical preparation [5].…”