Mediastinal Escherichia coli abscess during Fournier’s gangrene

Introduction: Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of origin in urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianal abscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found in tissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of a tertiary Hospital in reconstructing Fournier’s gangrene perineal defects and its detailed demography.Material and Methods: The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and Burns Department. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years including gender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructive techniques and its associated complications, additional surgical procedures and outcomes.Results: Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean, length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions (33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive technique complications with adequate final outcome.Discussion: In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus was the most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) had no identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, with a potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier’s gangrene identified.Conclusion: Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, are the mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuous deformities. Taking in account the single-center and retrospective observational character of the present study, these premises require proper validation from a multicenter prospective study.

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A Rare Case of Fournier’s Gangrene caused by Helcococcus kunzii

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2016.6.2.6 ◽

2016 ◽

Vol 6 (2) ◽

pp. 43-46

Author(s):

Mazen A. Badawi ◽

Maha M. Al-Alawi

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Rare Case ◽

Fournier’S Gangrene ◽

Local Infection ◽

Fournier's Gangrene ◽

Skin Flora ◽

Common Risk Factors ◽

And Staphylococcus Aureus ◽

Positive Coccus

Fournier’s gangrene is an acute rapidly progressing form of necrotizing fasciitis involving the genitalia and perianal regions. Trauma and local infection are the most common risk factors especially in the setting of diabetes. It is usually a polymicrobial infection caused by skin flora of the genital area. The most commonly isolated aerobic microorganism are Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus, while Bacteroides fragilis is a common culprit from the anaerobic group. We report a patient with Fournier’s gangrene caused by Helcococcus kunzii; anaerobic gram-positive coccus not known to be associated with Fournier’s gangrene before.

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The microbiological profile of patients with Fournier’s gangrene: A retrospective multi-institutional cohort study

Urologia Journal ◽

10.1177/03915603211018441 ◽

2021 ◽

pp. 039156032110184

Author(s):

Chiara Cipriani ◽

Valerio Iacovelli ◽

Marco Sandri ◽

Riccardo Bertolo ◽

Francesco Maiorino ◽

...

Keyword(s):

Escherichia Coli ◽

Scoring Systems ◽

Fournier’S Gangrene ◽

Fecal Diversion ◽

Fournier's Gangrene ◽

Related Factors ◽

Microbiological Profile ◽

Number Of Microorganisms ◽

Group A ◽

Group B

Objectives: To evaluate the role of the microbiological profile and of disease-related factors in the management of patients affected with Fournier’s gangrene (FG). Patients and methods: Data regarding patients admitted for FG at nine Italian Hospitals (March 2007–June 2018) were collected. Patients were stratified according to the number of microorganisms documented: Group A – one microorganism; Group B – two microorganisms; Group C – more than three microorganisms. Baseline blood tests, dedicated scoring systems, predisposing risk factors, disease’s features, management and post-operative course were analyzed. UpSet technique for visualizing set intersections in a matrix layout and Cuzick’s nonparametric test for trend across ordered groups were used. Results: Eighty-one patients were available for the analysis: 18 included in Group A, 32 in Group B, 31 in Group C. The most common microorganism isolated was Escherichia coli. In Group B-C, Escherichia coli was often associated to Enterococcus faecalis, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Statistically significant positive association was highlighted among the number of pathogens (Group A vs B vs C) and serum C-reactive Protein ( p < 0.001), procalcitonin ( p = 0.02) and creatinine ( p = 0.03). Scoring systems were associated with the number of microorganisms detected ( p < 0.02). A significant association between the number of microorganisms and the use of VAC therapy and need of a fecal diversion was found ( p < 0.02). The number of microorganisms was positively associated with the length of stay (LOS) ( p = 0.02). Ten weeks after initial debridement, wound closure was achieved in 11 (91.7%), 22 (84.6%) and 20 (80%) patients in Group A, B, and C, respectively, with no differences in overall survival. Conclusion: Polymicrobial infections in FG are positively associated with inflammatory scores, the need for fecal diversion and the LOS. This results may help the counseling and the clinical management of this rare niche of patients.

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Fournier's gangrene as Amyand's hernia complication

Perspectives in Surgery ◽

10.33699/pis.2019.98.7.291-296 ◽

2019 ◽

Vol 98 (7) ◽

pp. 291-296

Keyword(s):

Case Report ◽

Case Reports ◽

Rare Condition ◽

Sporadic Case ◽

Fournier’S Gangrene ◽

Amyand’S Hernia ◽

Fournier's Gangrene ◽

Randomized Controlled Studies ◽

Based Medicine ◽

Hernia Complication

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia. Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

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Fournier’s gangrene due to Salmonella Typhimurium in a healthy male: a rare aberrant infection

Infectious Disorders - Drug Targets ◽

10.2174/1871526520666201117143421 ◽

2020 ◽

Vol 20 ◽

Author(s):

Varsha Gupta ◽

Lipika Singhal ◽

Kritika Pal ◽

Mani Bhushan ◽

Rajeev Sharma ◽

...

Keyword(s):

Salmonella Typhimurium ◽

Systemic Disease ◽

External Genitalia ◽

Fournier’S Gangrene ◽

The Body ◽

Healthy Male ◽

Fournier's Gangrene ◽

Salmonella Infections ◽

Chief Complaints ◽

Human Infections

Introduction: Human Salmonella infections have been classically distinguised into diseases caused by typhoidal and non-typhoidal salmonella (NTS). Typhiodal salmonella includes S. enterica serovars Typhi and Paratyphi that cause the systemic disease but are restricted to human infections, while NTS consists mainly of other serovars that predominantly cause self-limiting gastroenteritis in humans. Localisation of foci with persisting infection occurs due to dissemination of the bacteria throughout the body and can cause a variety of rare clinical syndromes at aberrant sites. Fournier’s gangrene, a rapidly progressive, often fatal, necrotizing fasciitis of the external genitalia and perineum due to Salmonella Typhimurium, is a rare manifestation and has never been reported. Case: A 22-year-old male, apparently healthy patient with no relevant past medical history presented to surgical emergency with chief complaints of swelling of bilateral scrotal area. Infective etiology was considered and a diagnosis of fournier’s gangrene was made. Pure growth of Salmonella Typhimurium was obtained after repeated subculture and was identified biochemically and on serotyping, as Salmonella enterica serotype Typhimurium using specific antisera. Conclusion: In our case report, we describe a case of fournier’s gangrene due to Salmonella Typhimurium in an otherwise healthy male to highlight the unusual presentation of Non typhoidal salmonellae at an aberrant site. We also emphasize the importance of using selective media like Selenite F broth for isolation of Salmonella Typhimurium from a pus sample.

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Gangrena de Fournier. Reporte de caso

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.5.04 ◽

2020 ◽

Vol 63 (5) ◽

pp. 26-30

Author(s):

Paloma Pérez Ladrón de Guevara ◽

Georgina Cornelio Rodríguez ◽

Oscar Quiroz Castro

Keyword(s):

Mortality Rate ◽

Necrotizing Fasciitis ◽

Broad Spectrum ◽

Soft Tissues ◽

Fournier’S Gangrene ◽

Type Ii ◽

Necrotic Tissue ◽

Fournier's Gangrene ◽

Necrotizing Fascitis ◽

Key Words Fournier's Gangrene

Fournier’s Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics. Key words: Fournier’s gangrene; gangrene; necrotizing fasciitis; infectious necrotizing of soft tissues.

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Algorithm of rational approach to reconstruction in Fournier’s disease

Open Medicine ◽

10.1515/med-2021-0294 ◽

2021 ◽

Vol 16 (1) ◽

pp. 1028-1037

Author(s):

Domenico Tripodi ◽

Maria Ida Amabile ◽

Federica Gagliardi ◽

Federico Frusone ◽

Marzia Varanese ◽

...

Keyword(s):

Necrotizing Fasciitis ◽

Fournier’S Gangrene ◽

Rational Approach ◽

Skin Grafts ◽

Local Infection ◽

Fournier's Gangrene ◽

Rare Form ◽

Perineal Region ◽

Reconstructive Technique ◽

Diabetes And Obesity

Abstract Background Fournier’s gangrene is a rare form of necrotizing fasciitis that affects the genital area up to the perineal region and sometimes the abdominal wall. Objectives Our article aims to show that in the treatment of extensive forms of Fournier’s gangrene, correct use of flap and skin grafts and a quick reconstruction of the exposed tissues avoid scarring retraction of the testicles and deformation of the penis. Materials and methods We retrospectively reviewed the clinical and photographic data of Fournier’s gangrene cases treated at our Institute. The data were evaluated to obtain an estimate of the results of the reconstructive technique used, in terms of percentage of occurred healings and eventual complications. Results A total of 34 patients underwent surgery for Fournier’s gangrene. In nine cases (26.5%), we had minor complications: in four patients, suffering from diabetes and obesity, a retard in attachment of graft occurred, while in five patients with perianal problems there was a delay in healing due to the onset of local infection. Conclusion The reconstruction approach described here may reduce surgical times. In Fournier’s gangrene, the exposed tissues must be reconstructed as quickly as possible.

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Management of peno-scrotal wound defects in a tertiary hospital in North-Western Nigeria: a 20-year retrospective review

African Journal of Urology ◽

10.1186/s12301-021-00167-5 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Abubakar Sadiq Muhammad ◽

Ngwobia Peter Agwu ◽

Abdullahi Abduwahab-Ahmed ◽

Ahmed Mohammed Umar ◽

Muhammad Ujudud Musa ◽

...

Keyword(s):

Statistical Significance ◽

Graft Loss ◽

External Genitalia ◽

Tertiary Hospital ◽

Advancement Flap ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Direct Closure ◽

Secondary Intention ◽

North Western

Abstract Background Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. The management of these patients includes initial resuscitation and subsequent wound care with or without wound cover. The aim of this study is to document our experience in the management of peno-scrotal defects in a tertiary hospital of North-Western Nigeria. Methods This is a 20-year retrospective study of patients managed for peno-scrotal wound defects by the Urology Unit in the Department of Surgery of our hospital from January 2001 to December 2019. Data were collected from the patients’ case notes and entered into a proforma. Data were analysed using SPSS version 25.0. Results A total number of 54 patients with peno-scrotal wound defects were managed within the study period with the mean age of 46.27 ± 22.09 years and a range of six weeks to 107 years. The wound defects were sequelae of Fournier’s gangrene in 42 patients (77.8%) and traumatic in 12 patients (22.2%). Healing by secondary intention was achieved in 20 patients (37.0%). Direct closure was done in 17 patients (31.5%), skin graft in nine patients (16.7%), and advancement flap in eight patients (14.8%) depending on the location and size of the defects. Fourteen patients (26.0%) developed surgical site infection ± wound dehiscence and partial graft loss. The complication rate was higher in post-Fournier’s gangrene wound defects, but without statistical significance (p = 0.018). Conclusion Fournier’s gangrene and trauma to the external genitalia are the commonest causes of peno-scrotal wound defects in our environment. Smaller wound defects were healed by secondary intention, while larger defects required either direct closure or the use of advancement flap or skin grafting depending on the location and size of the wound. The study reported a higher post-repair complication in patients that had Fournier’s gangrene.

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