Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

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Fournier’s Gangrene as a Postoperative Complication of Inguinal Hernia Repair

Case Reports in Surgery ◽

10.1155/2014/408217 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Tolga Dinc ◽

Selami Ilgaz Kayilioglu ◽

Isa Sozen ◽

Baris Dogu Yildiz ◽

Faruk Coskun

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Postoperative Complication ◽

Inguinal Hernia Repair ◽

Broad Spectrum ◽

Recovery Period ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Broad Spectrum Antibiotics ◽

Aggressive Debridement

Fournier’s gangrene is the necrotizing fasciitis of perianal, genitourinary, and perineal regions. Herein, we present a case of scrotal Fournier’s gangrene as a postoperative complication of inguinal hernia repair. A 51-year-old male with giant indirect hernia is presented. Patient underwent inguinal hernia repair, and after an unproblematic recovery period, he was discharged. He applied to our outpatient clinic on the fifth day with swollen and painful scrotum and it turned out to be Fournier’s gangrene. Polypropylene mesh was not infected. Patient recovered and was discharged after repeated debridements. Basic principles in treatment of Fournier’s gangrene are comprised of initial resuscitation, broad-spectrum antibiotics therapy, and early aggressive debridement. In the management of presented case, aggressive debridement was made right after diagnosis and broad-spectrum antibiotics were given to the hemodynamically stable patient. In these circumstances, the important question is whether we could prevent occurrence of Fournier’s gangrene.

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Challenging Treatment of a Female Patient with Extensive Fournier’s Gangrene – Case Report

Prague Medical Report ◽

10.14712/23362936.2021.5 ◽

2021 ◽

Vol 122 (1) ◽

pp. 39-44

Author(s):

Ognen Kostovski ◽

Olivera Spasovska ◽

Gjorgji Trajkovski ◽

Svetozar Antovic ◽

Irena Kostovska ◽

...

Keyword(s):

Surgical Treatment ◽

Mortality Rate ◽

Female Patient ◽

Broad Spectrum ◽

Good Condition ◽

Fournier’S Gangrene ◽

Successful Outcome ◽

Fournier's Gangrene ◽

Broad Spectrum Antibiotics

Fournier’s gangrene (FG) is a necrotizing fasciitis of the genital, perianal and perineal regions, caused by multiple anaerobic/aerobic infection. It is a rare but very serious condition with multiple long-term complications and high mortality rate. Early diagnosis and multidisciplinary approach in treatment of complicated cases of FG are crucial to the successful outcome. We report a case of an extensive FG in a 59-years-old female patient with multiple risk factors such as obesity, type 2 diabetes and hypertension. She was hospitalized as an emergency case with diabetic ketoacidosis, sepsis and extensive necrotic lesions located perineal, perianal, genital and spread to inguinal, hypogastric, gluteal and sacrococcygeal region. Fournier’s gangrene was diagnosed, and after prompt resuscitation, intravenous fluids, broad-spectrum antibiotics, insulin infusion, emergency aggressive surgical debridement was performed. Several aerobic and anaerobic bacteria were isolated from wound culture and hemoculture. Patient has second debridement after four days. After second debridement was applied metabolic control, broad-spectrum antibiotics coverage, dressing the wound and negative pressure wound therapy (NPWT). Patient was discharged home five weeks after a second debridement in good condition. One month later she underwent reconstructive surgical treatment. Besides extensive FG and multiple comorbidity she was successfully managed with good outcome. Fournier’s gangrene remains a life-threatening and fulminant disease which need urgent diagnosis and aggressive medical and surgical treatment, to achieve a reduction in long term complications and mortality rate.

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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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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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Hyperbaric oxygen therapy adjunctive to surgical debridement in management of Fournier's gangrene: Usefulness of a severity index score in predicting disease gravity and patient survival

Actas Urológicas Españolas (English Edition) ◽

10.1016/j.acuroe.2011.01.007 ◽

2011 ◽

Vol 35 (6) ◽

pp. 332-338 ◽

Cited By ~ 3

Author(s):

A. Janane ◽

F. Hajji ◽

T.O. Ismail ◽

J. Chafiqui ◽

M. Ghadouane ◽

...

Keyword(s):

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Patient Survival ◽

Severity Index ◽

Fournier’S Gangrene ◽

Index Score ◽

Surgical Debridement ◽

Fournier's Gangrene ◽

Severity Index Score

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

BMJ Case Reports ◽

10.1136/bcr-2020-236503 ◽

2020 ◽

Vol 13 (10) ◽

pp. e236503

Author(s):

Edgardo Solis ◽

Yi Liang ◽

Grahame Ctercteko ◽

James Wei Tatt Toh

Keyword(s):

Delayed Diagnosis ◽

Case Series ◽

Perianal Abscess ◽

Scoring Systems ◽

Fournier’S Gangrene ◽

Necrotising Fasciitis ◽

Risk Indicator ◽

Fournier's Gangrene ◽

Perianal Sepsis

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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