Early surgical intervention within 15 hours results in survival benefit in Patients with fournier's gangrene

Abstract Anal stenosis is a rare debilitating surgical condition. The severity and level of the impacted region determines the management options. Numerous tension free anoplasty techniques and its varying success rates have been reported. A patient-tailored anoplasty approach depending on the severity, location, and extent of anal stenosis is rudimentary. We present a case of fused anus following extensive surgical debridement for Fournier’s Gangrene. Colonoscopy illumination guided neo-anal creation was performed, which resulted in low severe anal stenosis six weeks later. Subsequently, Y-V anoplasty, lateral internal sphincterotomy, and colostomy closure were done which showed good initial recovery. However, six months later, the anal stenosis recurred, for which diamond-shaped anoplasty was offered but patient had refused any further surgical intervention. The clinical management challenge and learning experience is shared within the report.

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Fournier’s gangrene mimicking an acute epididymitis

SAGE Open Medical Case Reports ◽

10.1177/2050313x211059297 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2110592

Author(s):

Kalee Larsen ◽

Amy Paige ◽

Monica Mutyala ◽

Benjamin Weber ◽

Jihad Slim

Keyword(s):

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Necrotizing Soft Tissue Infection ◽

Ultrasound Computed Tomography ◽

High Clinical Suspicion ◽

Uncontrolled Diabetes ◽

Immunocompromised State ◽

Acute Epididymitis ◽

Systemic Symptoms ◽

Early Surgical Intervention

Fournier’s gangrene is a urologic emergency secondary to a necrotizing soft tissue infection. Fournier’s gangrene is characterized by severe pain and features of Fournier’s gangrene may include edema, blisters and bullae, crepitus, subcutaneous gas, and systemic symptoms. Risk factors include male gender, alcohol abuse, immunocompromised state, uncontrolled diabetes mellitus, obesity, and malignancy. The diagnosis is made clinically but is often supported by radiography, ultrasound, computed tomography, and magnetic resonance imaging. Treatment consists of emergent hospitalization and surgery to debride the necrotic tissues. Morbidity and mortality for Fournier’s gangrene are very high if left untreated. Early surgical intervention is key to the successful treatment of Fournier’s gangrene. This case report presents a case of Fournier’s gangrene mimicking acute epididymitis and highlights the importance of a thorough physical examination with high clinical suspicion for Fournier’s gangrene.

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Perianal Infections in Patients With Hematologic Malignancy: The Risk of Fournier’s Gangrene Leading to Mortality and Irreversible Organ Damage

WOUNDS A Compendium of Clinical Research and Practice ◽

10.25270/wnds/091421.02 ◽

2021 ◽

Author(s):

Arife Simsek

Keyword(s):

Medical Therapy ◽

Surgical Intervention ◽

Hematologic Malignancy ◽

Organ Damage ◽

Fournier’S Gangrene ◽

Abscess Formation ◽

Anal Pain ◽

Perianal Region ◽

Fournier's Gangrene ◽

Diverting Ostomy

Introduction. The efficacy of surgical intervention for perianal infection in patients with hematologic malignancy is not well-established. Objective. This article presents a case series of perianal infection progressing to Fournier’s gangrene (FG) in patients with hematologic malignancy to guide physicians, because to the author’s knowledge, there were no randomized or prospective studies presenting the management strategies reported herein. It was hypothesized that surgery might reduce mortality and morbidity in patients with inflammation spreading beyond the perianal region, in patients with abscess formation, and in those who show no improvement with medical therapy. Materials and Methods. The data of 4 adults with hematologic malignancy who developed perianal infection progressing to FG between January 2010 and December 2018 were reviewed retrospectively. Patients younger than 18 years and patients without hematologic malignancies or FG were excluded. The primary outcome was mortality. The secondary outcome was irreversible organ damage. Results. Four male patients with a mean age of 36.75 years ± 13.1 standard deviation (range, 23–52 years) reported fever and dull anal pain during treatment for hematologic malignancy. A broad-spectrum antibiotic regimen was administered as initial empiric therapy at onset of fever and was de-escalated based on the culture results and clinical response. However, FG arose in all cases approximately 8.75 days ± 6.94 (range, 3–17 days) after onset of anal pain. All patients underwent surgical debridement, and diverting ostomy was performed in 3 cases. One patient died of overwhelming sepsis (25%), and 1 patient required orchiectomy (25%). Conclusions. Clinical suspicion of FG may be effective in reducing mortality in patients with hematologic malignancy, especially in cases with fever accompanied by anal pain. Surgical intervention may improve the prognosis for patients with inflammation spreading beyond the perianal region, patients with abscess formation, those who show no improvement in medical therapy, and those who develop FG. Diverting ostomy may improve survival in patients with FG.

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Location of residence and mortality for patients diagnosed with Fournier’s gangrene

Canadian Urological Association Journal ◽

10.5489/cuaj.6749 ◽

2020 ◽

Vol 15 (5) ◽

Author(s):

Rachel Wong ◽

Ruben Blachman-Braun ◽

Uday Mann ◽

Amanda Eng ◽

Sylvain Lother ◽

...

Keyword(s):

Surgical Intervention ◽

Multivariable Analysis ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Critical Determinant ◽

Surgical Interventions ◽

Tertiary Center ◽

Significant Difference ◽

Comorbidity Index ◽

Baseline Characteristics

Introduction: Fournier’s gangrene (FG) is a necrotizing infection of the genitalia. Time from to surgical intervention is a critical determinant of prognosis. We sought to investigate whether patients from rural locations have worse clinical outcomes given distance from a tertiary center. Methods: The Manitoba Intensive Care Unit (ICU) registry includes patients who have been admitted into ICUs across Manitoba. We identified patients admitted with FG from February 1999 to October 2019. Age, gender, Charlson comorbidity index (CCI), presence of colostomy and scrotal debridement, length of stay (LOS), and mortality outcomes were obtained. Patients were categorized as being rural or urban. Results: From 1999–2019, a total of 79 patients were admitted with FG. The median age was 60 years [interquartile range [IQR] 48–67). The mortality rate during hospitalization was 16.5%. There was no statistically significant difference in the number of deaths for patients from urban vs. rural dwellings (9/47 [19.1%] vs. 4/32 [12.5%], p=0.434]. A comparison of the 66 (83.5%) patients that survived and the 13 (16.5%) that died during ICU hospitalization demonstrated no difference in age, gender, CCI, presence of colostomy, and rates of scrotal re-debridement (p>0.05). Multivariable analysis demonstrated that living in a rural area was not associated with increased mortality (odds ratio 0.64, 95% confidence interval 00.16–2.57, p=0.527). Conclusions: Location of residence was not predictive of death from FG. In addition, baseline characteristics such as age, gender, CCI, surgical interventions, or LOS were not found to be associated with mortality.

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Impact of surgical intervention timing on the case fatality rate for Fournier's gangrene: an analysis of 379 cases

BJU International ◽

10.1111/j.1464-410x.2012.11291.x ◽

2012 ◽

Vol 110 (11c) ◽

pp. E1096-E1100 ◽

Cited By ~ 35

Author(s):

Toru Sugihara ◽

Hideo Yasunaga ◽

Hiromasa Horiguchi ◽

Tetsuya Fujimura ◽

Kazuhiko Ohe ◽

...

Keyword(s):

Case Fatality Rate ◽

Surgical Intervention ◽

Case Fatality ◽

Fournier’S Gangrene ◽

Fatality Rate ◽

Fournier's Gangrene

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Impact of aggressive surgical intervention in fournier's gangrene and its correlation to the outcome in patients at a rural hospital

International Journal of Medical Research & Health Sciences ◽

10.5958/2319-5886.2015.00009.0 ◽

2015 ◽

Vol 4 (1) ◽

pp. 53

Author(s):

M.H. Shaikh ◽

Puneet Singh ◽

Tausif Syed Kamal ◽

Simran Shaikh

Keyword(s):

Surgical Intervention ◽

Fournier’S Gangrene ◽

Rural Hospital ◽

Fournier's Gangrene

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Fournier’s Gangrene of the Shoulder Girdle

Pathogenic Bacteria ◽

10.5772/intechopen.92385 ◽

2020 ◽

Author(s):

Gyoguevara Patriota ◽

Luiz Marcelo Bastos Leite ◽

Nivaldo Cardozo Filho ◽

Paulo Santoro Belangero ◽

Benno Ejnisman

Keyword(s):

Early Diagnosis ◽

High Mortality ◽

Human Body ◽

Surgical Intervention ◽

Subcutaneous Tissue ◽

Shoulder Girdle ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Progressive Necrosis

Fournier’s gangrene is uncommon, a high-mortality infection that affects the subcutaneous tissue with rapidly progressive necrosis. Reports on cases involving the shoulder girdle are more rare. Similar to the presentation on other regions of the human body, fundamental is early diagnosis and surgical intervention.

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