Prospective evaluation of risk factors for mortality in patients of Fournier′s gangrene: A single center experience

Vyas, Hari Gopal; Kumar, Anup; Bhandari, Vasundhra; Kumar, Niraj; Jain, Abhinav; Kumar, Rohit

doi:10.4103/0970-1591.117255

Cited by 28 publications

(17 citation statements)

References 24 publications

(38 reference statements)

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“…However, there is still major controversy regarding the necessity of an interval appendectomy after successful nonoperative treatment of periappendicular abscess . To our knowledge, there is only 1 published randomized clinical trial comparing nonsurgical follow-up with interval appendectomy, with a small number of patients (N = 60) and an additional third intervention group of patients who received delayed appendectomy during the initial hospitalization phase of the study …”

Section: Introductionmentioning

confidence: 99%

“…3,5 To our knowledge, there is only 1 published randomized clinical trial comparing nonsurgical follow-up with interval appendectomy, with a small number of patients (N = 60) and an additional third intervention group of patients who received delayed appendectomy during the initial hospitalization phase of the study. 17 The aim of this randomized clinical trial, Peri-Appendicitis Acuta (PeriAPPAC), was to test the hypothesis that an interval appendectomy is unnecessary after initial successful nonoperative treatment of a periappendicular abscess, by comparing routine interval appendectomy to follow-up with magnetic resonance imaging (MRI) at 3 months after the initial treatment.…”

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confidence: 99%

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Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging

et al. 2019

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IMPORTANCE The step after conservative treatment of periappendicular abscess arouses controversy, ranging from recommendations to abandon interval appendectomy based on low recurrence rates of the precipitating diagnosis to performing routine interval appendectomy owing to novel findings of increased neoplasm risk at interval appendectomy. To our knowledge, there are no randomized clinical trials with sufficient patient numbers comparing these treatments. OBJECTIVE To compare interval appendectomy and follow-up with magnetic resonance imaging after initial successful nonoperative treatment of periappendicular abscess. DESIGN, SETTING, AND PARTICIPANTS The Peri-Appendicitis Acuta randomized clinical trial was a multicenter, noninferiority trial conducted in 5 hospitals in Finland. All patients between age 18 and 60 years with periappendicular abscess diagnosed by computed tomography and successful initial nonoperative treatment from January 2013 to April 2016 were included. Data analysis occurred from April 2016 to September 2017. INTERVENTIONS Patients were randomized either to interval appendectomy or follow-up with magnetic resonance imaging; all patients underwent colonoscopy. MAIN OUTCOMES AND MEASURES The primary end point was treatment success, defined as an absence of postoperative morbidity in the appendectomy group and appendicitis recurrence in the follow-up group. Secondary predefined end points included neoplasm incidence, inflammatory bowel disease, length of hospital stay, and days of sick leave. RESULTS A total of 60 patients were included (36 men [60%]; median [interquartile range] age: interval appendectomy group, 49 [18-60] years; follow-up group, 47 [22-61] years). An interim analysis in April 2016 showed a high rate of neoplasm (10 of 60 [17%]), with all neoplasms in patients older than 40 years. The trial was prematurely terminated owing to ethical concerns. Two more neoplasms were diagnosed after study termination, resulting in an overall neoplasm incidence of 20% (12 of 60). On study termination, the overall morbidity rate of interval appendectomy was 10% (3 of 30), and 10 of the patients in the follow-up group (33%) had undergone appendectomy. CONCLUSIONS AND RELEVANCE The neoplasm rate after periappendicular abscess in this small study population was high, especially in patients older than 40 years. If this considerable rate of neoplasms after periappendicular abscess is validated by future studies, it would argue for routine interval appendectomy in this setting.

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Section: Introductionmentioning

confidence: 99%

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Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging

et al. 2019

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“…8 It can affect all age groups (mean age of 50) with a male predominance. 9 The clinical appearance of FG is almost similar to cellulitis. The difference is that cellulitis is a surface infection without necrotic tissue, whereas microbes in Fournier disease cause infection of the small subdermal artery vessels leading to thrombosis.…”

Section: Discussionmentioning

confidence: 98%

Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene

Xie

et al. 2015

Medicine

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Fournier gangrene is a rare but highly infectious disease characterized by fulminant necrotizing fasciitis involving the genital and perineal regions. Negative pressure wound therapy (NPWT; KCI USA Inc, San Antonio, TX) is a widely adopted technique in many clinical settings. Nevertheless, its application and effect in the treatment of Fournier gangrene are unclear.A 47-year-old male patient was admitted with an anal abscess followed by a spread of the infection to the scrotum, which was caused by Pseudomonas aeruginosa. NPWT was applied on the surface of the scrotal area and continued for 10 days. A split-thickness skin graft from the scalp was then grafted to the wound, after which, NPWT utilizing gauze sealed with an occlusive dressing and connected to a wall suction was employed for 7 days to secure the skin graft.At discharge, the percentage of the grafted skin alive on the scrotum was 98%. The wound beside the anus had decreased to 4 × 0.5 cm with a depth of 1 cm. Follow-up at the clinic 1 month later showed that both wounds had healed. The patient did not complain of any pain or bleeding, and was satisfied with the outcome.NPWT before and after split-thickness skin grafts is safe, well tolerated, and efficacious in the treatment of Fournier gangrene.

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“…A narrative review of the literature was performed on PubMed and Scopus using as researching terms “Fournier’s gangrene” and “necrotizing fasciitis”. All the available English language full-text original article, case series, case report of interest, published from January 2013 until December 2021, were reported in the Table 1 [ 10 – 198 ]. Review articles, meeting reports and congress poster and abstracts were all excluded.…”

Section: Introductionmentioning

confidence: 99%

Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

Paladini

Cochetti

Tancredi

et al. 2022

Basic Clin. Androl.

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Background Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed. We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed. Case presentation A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day. Conclusions FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.

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Prospective evaluation of risk factors for mortality in patients of Fournier′s gangrene: A single center experience

Cited by 28 publications

References 24 publications

Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging

Risk of Appendiceal Neoplasm in Periappendicular Abscess in Patients Treated With Interval Appendectomy vs Follow-up With Magnetic Resonance Imaging

Negative Pressure Wound Therapy Applied Before and After Split-Thickness Skin Graft Helps Healing of Fournier Gangrene

Management of Fournier’s gangrene during the Covid-19 pandemic era: make a virtue out of necessity

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