Neonatal Fournier’s gangrene; pattern and predisposing factors in a tertiary health facility in Southern Nigeria

2021 ◽  
pp. 004947552110480
Author(s):  
Okoro Philemon E ◽  
Igwe Promise W ◽  
Alinnor Ezioma A ◽  
Okoro Chinwendu A ◽  
Nwiwu Princewill
Keyword(s):  
Health Facility ◽  
Early Recognition ◽  
Pathological Condition ◽  
Mode Of Delivery ◽  
Fournier’S Gangrene ◽  
Hot Water ◽  
Fournier's Gangrene ◽  
Wound Debridement ◽  
Potential Factors ◽  
Service Data

Fournier’s gangrene (FG), a necrotizing fasciitis of the genital and perineal region, is a serious and debilitating multi-infective pathological condition. More commonly seen in adults, its occurrence in neonates is uncommon. We share our experience with neonatal FG (NFG), highlighting potential factors which may predispose neonates to it. Ours is a five year retrospective review of cases of NFG in our service. Data obtained included health facility of birth, mode of delivery, symptoms and duration, investigation results, treatment and outcome. Sixteen neonates were included, comprising 13 males (M:F  =  4.3:1). Fourteen were delivered outside our centre; breech vaginal delivery, hot water massaging and application of native concoctions were common. All were treated with antibiotics and wound debridement, but five (37.5%) died.NFG is not that rare in our service. Early recognition is imperative to reduce mortality. Neonates delivered by breech vaginally may be particularly at risk.

scholarly journals Predisposition Factors Analysis for Fournier’s Gangrene Defects Closure Complication

2021 ◽  
Vol 5 (1) ◽  
pp. 13
Author(s):  
Bayu Fasi Bermani ◽  
Sitti Rizaliyana ◽  
Ira Handriani
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Medical Records ◽  
Early Recognition ◽  
Severe Disease ◽  
Case Series ◽  
Fournier’S Gangrene ◽  
Defect Closure ◽  
Fournier's Gangrene ◽  
Fournier Gangrene

Background: Fournier’s gangrene is a rare and rapidly progressive, necrotizing fasciitis affecting the external genitalia and perineum. Based on the case series that have been reported, the incidence rate of this case is 88% with mortality rate of 20%-40%. The study aims to share our policy in managing Fournier’s gangrene and identifying risk factors that can affect the outcome of defect closure.Method: The medical records of 10 patients with Fournier’s gangrene who presented at the Dr. Soetomo Hospital Surabaya from January 2017 to December 2018 were reviewed retrospectively. We analyzed characteristics of the patients, risk factors, methods of defect closure, and case outcome. There are 10 Fournier’s gangrene patients at Dr. Soetomo Academic General Hospital from January 2017 to December 2018. We analyzed the patient’s medical records retrospectively on the patient’s characteristics, risk factors, method of closing Fournier’s gangrene defects, and the final outcome of the case.Results: There were ten men enrolled in the study, and the mean age was 49.3 ± 11.51 years. All patients received broad-spectrum antibiotic therapy, and extensive surgical excision. This study found that diabetes mellitus and uncontrolled patient blood sugar levels, statistically there is no effect on failure of defect closure in Fournier gangrene patients, but clinically, the relative risk value shows that blood glucose levels have a risk factor of 6 times. increasing the incidence of failure to close the Fournier gangrene defect.Conclusions: Fournier’s gangrene is still considered a severe disease with fairly high mortality rate. Early recognition of predisposition factors associated with invasive and aggressive treatment options is very important in efforts to to reduce morbidity.

scholarly journals A clinical study of management of Fournier’s gangrene in a rural hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1524
Author(s):  
Purushotham T. Shivaraju ◽  
Ponnappa B. Ganapathy ◽  
Naveen N. ◽  
Pruthvika N.
Keyword(s):  
Soft Tissue ◽  
Hospital Stay ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Surgical Reconstruction ◽  
Reconstructive Procedure ◽  
Soft Tissue Defects ◽  
Fournier's Gangrene ◽  
Wound Debridement ◽  
Tissue Defects

Background: Fournier’s gangrene is a potentially life threatening synergistic necrotising fascitis of external genitalia and perineal tissues. It commonly affects young men but can also affect women and children. The use of broad spectrum antibiotics and serial wound debridement is the main stay of treatment. The reconstruction of soft tissue defect following the debridement is a challenging task. The purpose of this study is to evaluate the surgical reconstruction methods of soft tissue defects due to Fournier's gangrene.Methods: This was a prospective study conducted in Adichunchanagiri Institute of Medical Sciences from January 2015 to December 2017. All patients with necrotizing fascitis of external genitalia and perineum, irrespective of age and gender, were included. Parameters such as age, gender, aetiology, predisposing factors, clinical features, defect location, type of bacterial flora, sort of reconstructive procedure used, and duration of hospital stay, post-operative pain, patient satisfaction and mortality, if any, were studied. The choice of reconstructive procedure was based on severity of defect, availability of local tissue and patient preference.Results: Out of 31 cases included in the study, 30 patients underwent reconstructive procedures. The age range was 4 to 74 years (mean 38.5). The commonest presentation was pain, scrotal swelling and fever. The most common aetiology was urogenital diseases. 10 patients were treated by split-thickness skin graft, 5 by secondary suturing, 2 by unilateral superomedial thigh flap, 4 by bilateral superomedial thigh flap, 5 by tensor fascia lata flap, 2 by medial thigh V-Y advancement flap, 2 with perineal artery flap and one case healed by secondary intention.Conclusions: This study suggests that earlier presentation, with early diagnosis and intervention with prompt debridement and appropriate, appropriate antibiotics are the main stays of treatment. The resulting soft tissue defects following wound debridement required surgical reconstruction, except in one case, thus decreasing morbidity, hospital stay and early return of patients to regular life.

scholarly journals Fournier's Gangrene as Seen in University of Maiduguri Teaching Hospital

ISRN Urology ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
S. Aliyu ◽  
A. G. Ibrahim ◽  
N. Ali ◽  
A. M. Waziri
Keyword(s):  
Poor Prognosis ◽  
Obstructive Uropathy ◽  
Fournier’S Gangrene ◽  
Hiv Positive ◽  
Fournier's Gangrene ◽  
Scrotal Pain ◽  
Wound Debridement ◽  
Aggressive Management ◽  
The Tropics ◽  
Predisposing Conditions

Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier’s gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier’s gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome.

scholarly journals Fournier's Gangrene Complicating Hematologic Malignancies: Literature Review and Treatment Suggestions

2013 ◽  
Vol 5 (1) ◽  
pp. e2013067 ◽  
Author(s):  
Giovanni D'Arena ◽  
Giuseppe Pietrantuono ◽  
Emilio Buccino ◽  
Giancarlo Pacifico ◽  
Pellegrino Musto
Keyword(s):  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Clinical Course ◽  
Early Recognition ◽  
Severe Disease ◽  
External Genitalia ◽  
Hematologic Malignancies ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Appropriate Treatment

Fournier’s gangrene (FG) is a rare but severe necrotizing fasciitis of the external genitalia that may complicate the clinical course of hematologic malignancies and sometimes may be the first sign of the disease. The clinical course of FG is very aggressive and the mortality is still high despite the improvement in its management. Early recognition of FG and prompt appropriate treatment with surgical debridement and administration of antibiotics are the cornerstone of the management of this very severe disease.

scholarly journals It's Fournier's gangrene still dangerous?

2009 ◽  
Vol 56 (1) ◽  
pp. 77-80
Author(s):  
S. Bilali ◽  
E. Celiku ◽  
V. Bilali
Keyword(s):  
Clinical Symptoms ◽  
Early Recognition ◽  
Fournier’S Gangrene ◽  
University Hospital ◽  
Prognostic Indicators ◽  
Fournier's Gangrene ◽  
Significant Difference ◽  
Radical Debridement ◽  
Aggressive Debridement ◽  
The University

Background: Fournier's gangrene is known to have an impact in the morbidity and despite antibiotics and aggressive debridement, the mortality rate remains high. Objectives: To assess the morbidity and mortality in the treatment of Fournier's gangrene in our experience. Methods: The medical records of 14 patients with Fournier's gangrene who presented at the University Hospital Center 'Mother Teresa' from January 1997 to December 2006 were reviewed retrospectively to analyze the outcome and identify the risk factor and prognostic indicators of mortality. Results: Of the 14 patients, 5 died and 9 survived. Mean age was 54 years (range from 41-61): it was 53 years in the group of survivors and 62 years in deceased group. There was a significant difference in leukocyte count between patients who survived (range 4900-17000/mm3) and those died (range 20.300- 31000/mm3). Mean hospital stay was about 19 days (range 2-57 days). Conclusion: The interval from the onset of clinical symptoms to the initial surgical intervention seems to be the most important prognostic factor with a significant impact on outcome. Despite extensive therapeutic efforts, Fournier's gangrene remains a surgical emergency and early recognition with prompt radical debridement is the mainstays of management.

scholarly journals Fournier’s gangrene. A clinical review

2016 ◽  
Vol 88 (3) ◽  
pp. 157 ◽  
Author(s):  
Ariana Singh ◽  
Kamran Ahmed ◽  
Abdullatif Aydin ◽  
Muhammad Shamim Khan ◽  
Prokar Dasgupta
Keyword(s):  
Mortality Rate ◽  
High Mortality ◽  
Early Recognition ◽  
Care Pathway ◽  
Disease Process ◽  
Fournier’S Gangrene ◽  
Prognostic Indicators ◽  
Fournier's Gangrene ◽  
Randomized Controlled Studies ◽  
Clinical Awareness

Introduction and Hypothesis: Fournier’s gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier’s gangrene with emphasis on early diagnosis and management. This review aims to highlight the relevant research surrounding Fournier’s gangrene, in particular the various prognostic indicators and management strategies. Methods: A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. In addition to which a search of the European Association of Urology, the British Association for Urological Surgeons and the British Medical Journal was conducted for the most recent recommendations. Results: Immediate broad-spectrum antibiotic therapy and urgent surgical debridement are the core managerial principles of Fournier’s gangrene. The use of adjunctive therapies such as hyperbaric oxygen and vacuum assisted closure are supported in some aspects of the literature and disputed in others. The lack of randomized controlled studies limits the use of these potential additional therapies to patients unresponsive to conventional management. The value of unprocessed honey as a topical antimicrobial agent has been highlighted in the literature for small lesions in uncomplicated patients. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate despite advances in the medical and surgical fields. The aggressive nature of the infection advocates the need for early recognition allowing immediate surgical intervention. The opposing results of available research as well as the lack of high quality evidence surrounding emergent therapies prevents their routine use in the management of Fournier’s gangrene. The absence of a specific care pathway may hinder efficient management of Fournier’s gangrene, thus based on current guidelines a management pathway is suggested.

scholarly journals Pattern of presentation and outcome of patients treated for Fournier’s gangrene at Kilimanjaro Christian Medical Centre in Moshi, Tanzania

2016 ◽  
Vol 18 (4) ◽  
Author(s):  
Paschal Mabula ◽  
Obadia V. Nyongole ◽  
Kien A. Mteta
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Fournier’S Gangrene ◽  
Medical Centre ◽  
Fluid Replacement ◽  
Comorbid Condition ◽  
Fournier's Gangrene ◽  
Average Hospital ◽  
Wound Debridement ◽  
Kilimanjaro Christian Medical Centre

Background: Fournier’s gangrene (FG) is a rapidly progressive and potentially fatal infective necrotizing fasciitis which affects the perineal and perianal regions as well as the external genitalia. This study aimed at evaluating the management of FG and its outcomes at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, TanzaniaMethods: This was a retrospective hospital based study involving case notes of all patients who had Fournier’s gangrene at KCMC from January 2003 to December 2013. Patients managed for Fournier’s gangrene and the medical records of the patients eligible for the study retrieved manually.Results: A total of 25case notes of patients treated for Fournier’s gangrene during the study period were reviewed. All were males and majority of them (60%) were ≥50 years (mean=57.4 years). Hypertension was the commonest reported risk factor (41%). Diabetes mellitus was reported as a risk factor in 20% of all patients with FG. These risk factors were mentioned as comorbid conditions in traumatic urethral catheterization and suprapubic catheterization. All patients received a combination treatment of wound debridement, antibiotics, fluid replacement, analgesics and daily wound dressing. The average hospital stay for patients with FG was about 25 days.Conclusion: Fournier’s gangrene at KCMC is exclusively a male disease affecting those above 50 years. Hypertension and diabetes mellitus were the common comorbid condition in patients with Fournier’s gangrene.

Fournier’s Gangrene in a Neonate: A Case Report

1970 ◽  
Vol 30 (3) ◽  
pp. 166-167
Author(s):  
B Baghel ◽  
K Dhruv
Keyword(s):  
Case Report ◽  
Blood Culture ◽  
Abdominal Distension ◽  
Generation Cephalosporin ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Wound Debridement ◽  
Secondary Intention ◽  
Scrotal Swelling ◽  
Key Words Fournier's Gangrene

A 15 days newborn presented to paediatric OPD for evaluation of abdominal distension, not accepting feed properly and scrotal swelling. On examination gangrene was found on the scrotum, blood culture showed growth of streptococcal organism. Patient was treated with 3rd generation cephalosporin and local debridement of gangrenous scrotal tissue. Wound got healed by secondary intention and patient was discharged alive and healthy. The outcome of treatment of Fournier’s gangrene in neonate is good. Key words: Fournier’s gangrene; Septicemia; Scrotal swelling; Phimosis; Wound debridement. DOI: 10.3126/jnps.v30i3.3921J Nep Paedtr Soc 2010;30(3):166-167

scholarly journals Association between atherogenic dyslipidemia and fournier’s gangrene

2020 ◽  
Vol 66 (4) ◽  
pp. 479-484
Author(s):  
Serkan Akan ◽  
Ahmet Urkmez
Keyword(s):  
Patient Care ◽  
Reconstructive Surgery ◽  
Fournier’S Gangrene ◽  
Atherogenic Dyslipidemia ◽  
Fournier's Gangrene ◽  
Normal Range ◽  
Wound Debridement ◽  
Normal Triglyceride ◽  
The Difference ◽  
Care Costs

SUMMARY OBJECTIVE We aimed to determine whether atherogenic dyslipidemia is associated with the disease and morbidity in our patients treated for Fournier’s gangrene (FG). METHODS Sixty-two patients who were treated with the diagnosis of FG at our center between 2012 and 2017 were retrospectively screened. RESULTS The triglyceride values of the patients who required reconstructive surgery were statistically significantly higher than those of the patients for whom wound debridement and primary suturing was sufficient (p:0.001). A total of 65.7% of the patients had normal triglyceride values in the group in which wound debridement and primary suturing was sufficient, while this rate was 22.2% in the group of patients who needed reconstructive surgery; the difference was statistically significant (p: 0.002). The UFGSI score of those with triglyceride values higher than the normal range was statistically significantly higher (p:0.006). The cut-off point for the triglyceride value for which Fournier’s gangrene was more morbid and the probability of reconstructive surgery need was significantly higher, i.e., >233mg. CONCLUSION Our study has demonstrated that atherogenic dyslipidemia, especially hypertriglyceridemia, is an important factor affecting morbidity and associated with high patient care costs after hospitalization and discharge in FG.

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