Dangers of delayed diagnosis of perianal abscess and undrained perianal sepsis in Fournier’s gangrene: a case series

Fournier’s gangrene (FG) is a rapidly progressing infective necrotising fasciitis of the perianal, perineal and genital region. It is characterised by its aggressive nature and high mortality rates of between 15% and 50%. While it has been commonly found to primarily develop from urological sources, there have been increasing reports of the role of colorectal sources as the underlying aetiology of FG. Presented is a case series of four FG presentations at a single institution during a 12-month period as a result of underlying untreated perianal disease highlighting its dangers in progressing to a deadly infection, advocating for early and aggressive surgical debridement, and the role of adjunct scoring systems, such as Laboratory Risk Indicator for Necrotising Fasciitis, in guiding clinical diagnosis.

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A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

BMC Surgery ◽

10.1186/s12893-020-00916-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nan Zhang ◽

Xin Yu ◽

Kai Zhang ◽

Tongjun Liu

Keyword(s):

Necrotizing Fasciitis ◽

Case Series ◽

Fournier’S Gangrene ◽

Wound Management ◽

Risk Indicator ◽

Fournier's Gangrene ◽

Retrospective Case ◽

Female Ratio ◽

Male Predominance ◽

Lrinec Score

Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented. Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits. Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

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A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

10.21203/rs.3.rs-41628/v2 ◽

2020 ◽

Author(s):

Nan Zhang ◽

Xin Yu ◽

Kai Zhang ◽

Tongjun Liu

Keyword(s):

Necrotizing Fasciitis ◽

Case Series ◽

Fournier’S Gangrene ◽

Wound Management ◽

Risk Indicator ◽

Fournier's Gangrene ◽

Retrospective Case ◽

Female Ratio ◽

Male Predominance ◽

Lrinec Score

Abstract Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

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A retrospective case series of Fournier’s gangrene: necrotizing fasciitis in perineum and perianal region

10.21203/rs.3.rs-41628/v3 ◽

2020 ◽

Author(s):

Nan Zhang ◽

Xin Yu ◽

Kai Zhang ◽

Tongjun Liu

Keyword(s):

Necrotizing Fasciitis ◽

Case Series ◽

Fournier’S Gangrene ◽

Wound Management ◽

Risk Indicator ◽

Fournier's Gangrene ◽

Retrospective Case ◽

Female Ratio ◽

Male Predominance ◽

Lrinec Score

Abstract BackgroundTo describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement.MethodsWe retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented.ResultsThere were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits.ConclusionsFournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.

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A contemporary case series of Fournier’s gangrene at a Swiss tertiary care center—can scoring systems accurately predict mortality and morbidity?

World Journal of Emergency Surgery ◽

10.1186/s13017-018-0187-0 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 4

Author(s):

C. Wetterauer ◽

J. Ebbing ◽

A. Halla ◽

R. Kuehl ◽

S. Erb ◽

...

Keyword(s):

Care Center ◽

Tertiary Care ◽

Case Series ◽

Scoring Systems ◽

Fournier’S Gangrene ◽

Tertiary Care Center ◽

Fournier's Gangrene ◽

Mortality And Morbidity

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Re: Rapid progression of perianal abscess into Fournier's gangrene

ANZ Journal of Surgery ◽

10.1111/ans.12952 ◽

2015 ◽

Vol 85 (3) ◽

pp. 198-198

Author(s):

Duncan R. Bayne ◽

Dariush Nikkhah

Keyword(s):

Perianal Abscess ◽

Fournier’S Gangrene ◽

Rapid Progression ◽

Fournier's Gangrene

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AB185. SOH21AS226. The management of Fournier’s Gangrene in an Irish university hospital: a case series

Mesentery and Peritoneum ◽

10.21037/map-21-ab185 ◽

2021 ◽

Vol 5 ◽

pp. AB185-AB185

Author(s):

Lynda Condell ◽

Morgan Peter McMonagle ◽

Megan Power-Foley

Keyword(s):

Case Series ◽

Fournier’S Gangrene ◽

University Hospital ◽

Fournier's Gangrene

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Fournier's Gangrene of Genitalia: Case Report

Urologia Journal ◽

10.1177/039156030307001-408 ◽

2003 ◽

Vol 70 (1-4) ◽

pp. 38-40

Author(s):

P. Salciccia ◽

G. Poveromo ◽

S. Salciccia

Keyword(s):

Septic Shock ◽

Case Report ◽

Early Diagnosis ◽

Rare Disease ◽

Abdominal Wall ◽

Sudden Onset ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Prodromal Symptoms

Fournier's gsngrene is a rare disease involving the scrotum and the penis with occasional extension up to the abdominal wall. The etiology of the disease, commonly without prodromal symptoms and with sudden onset, is still not fully understood. The organisms are usually streptococcus haemoliticus and/or anerobic bacteria. We report a case of Fournier's gangrene, presenting septic shock. The patient was treated with reanimatory care, antibiotics, local excision and debridment. Speaking about anatomical and etiopathogenetic hypotheses, we discuss the diagnostic problems and the treatment of the disease. We emphasize the role of the early diagnosis.

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