Fournier’s gangrene: a clinical profile of 30 cases

Background: Fournier's gangrene is a rapidly progressive synergistic infection involving the perineal region and the scrotum and/or the penis. This study was conducted to know about the etiology and mode of presentation of Fournier’s gangrene and the impact of early and aggressive multimodality treatment in reduction in morbidity and mortality associated with this condition which is still considered to be significantly high.Methods: The medical records of 30 patients of Fournier's gangrene who presented to the hospital between May 2014 to June 2017 were retrospectively reviewed to analyze the presentation, progression and the outcome of the disease.Results: The study included a total of 30 male patients. The mean age was 57 years (range 38-72 years). The most common etiology was secondary to anorectal pathology (40%). The most common predisposing factor was noticed to be diabetes mellitus (73.34%). Pain and tenderness in the perineal region was present in most of the patients and scrotal involvement was seen in 66.67% of the patients. Fever was the most common prodromal condition seen in 93.33% all of which in turn were associated with tachycardia. Hyperleukocytosis was seen in 93.33% of patients except for one patient who was diagnosed to be retropositive on admission. The microbiological profile yielded polymicrobial culture report in 80% of the patients and monomicrobial in the rest with Escherichia coli being the most common organism isolated from 80% of the patients. All patients underwent adequate resuscitation, primary emergency debridement with parenteral antibiotic therapy. All the patients recovered after a mean hospital stay of 16.93 days (range 9-30 days). The mortality rate in present study was found to be 6.67%.Conclusions: In spite of the advancements in the field of medicine Fournier’s gangrene still remains a disease with questionable degree of morbidity and mortality and early detection and treatment with aggressive debridement seems to be the only way of obtaining a good prognosis in these patients.

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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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Fournier's Gangrene: Non-Clostridial Gas Gangrene of the Perineum and Diabetes Mellitus

Journal of the Royal Society of Medicine ◽

10.1177/014107688607900408 ◽

1986 ◽

Vol 79 (4) ◽

pp. 212-215 ◽

Cited By ~ 9

Author(s):

A J Lamerton

Keyword(s):

Diabetes Mellitus ◽

Fournier’S Gangrene ◽

Gas Gangrene ◽

Fournier's Gangrene ◽

Predisposing Factor

Three successfully managed cases of Fournier's gangrene, all with diabetes, are reported. A simple bacteriological classification is offered and the importance of diabetes mellitus as a predisposing factor is stressed.

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Real-world evidence on sodium-glucose cotransporter-2 inhibitor use and risk of Fournier’s gangrene

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-000985 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000985 ◽

Cited By ~ 3

Author(s):

Jeff Yufeng Yang ◽

Tiansheng Wang ◽

Virginia Pate ◽

John B Buse ◽

Til Stürmer

Keyword(s):

Real World ◽

Fournier’S Gangrene ◽

Sensitivity Analyses ◽

Standardized Mortality Ratio ◽

Fournier's Gangrene ◽

Diagnosis Codes ◽

Sodium Glucose Cotransporter ◽

Real World Evidence ◽

Increased Risk ◽

The Impact

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with increased occurrence of Fournier’s gangrene (FG), a rare but serious form of necrotizing fasciitis, leading to a warning from the Food and Drug Administration. Real-world evidence on FG is needed to validate this warning.MethodsWe used data from IBM MarketScan (2013–2017) to compare the incidence of FG among adult patients who initiated either SGLT2i, a dipeptidyl peptidase-4 inhibitor (DPP4i), or any non-SGLT2i antihyperglycemic medication. FG was defined using inpatient International Classification of Diseases, Ninth Edition and Tenth Edition diagnosis codes 608.83 and N49.3, respectively, combined with procedure codes for debridement, surgery, or systemic antibiotics. We estimated crude incidence rates (IRs) using Poisson regression, and crude and adjusted HRs (aHR) and 95% CIs using standardized mortality ratio-weighted Cox proportional hazards models. Sensitivity analyses examined the impact of alternative outcome definitions.ResultsWe identified 211 671 initiators of SGLT2i (n=93 197) and DPP4i (n=118 474), and 305 329 initiators of SGLT2i (n=32 868) and non-SGLT2i (n=272 461). Crude FG IR ranged from 3.2 to 3.8 cases per 100 000 person-years during a median follow-up of 0.51–0.58 years. Compared with DPP4i, SGLT2i initiation was not associated with increased risk of FG for any outcome definition, with aHR estimates ranging from 0.25 (0.04–1.74) to 1.14 (0.86–1.51). In the non-SGLT2i comparison, we observed an increased risk of FG for SGLT2i initiators when using FG diagnosis codes alone, using all diagnosis settings (aHR 1.80; 0.53–6.11) and inpatient diagnoses only (aHR 4.58; 0.99–21.21).ConclusionsNo evidence of increased risk of FG associated with SGLT2i was observed compared with DPP4i, arguably the most relevant clinical comparison. However, uncertainty remains based on potentially higher risk in the broader comparison with all non-SGLT2i antihyperglycemic agents and the rarity of FG.Trial registration numberEUPAS Register Number 30018.

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PROTETIVE COLOSTOMY IN FOURNIER’S GANGRENE

Revista de Patologia do Tocantins ◽

10.20873/uft.2446-6492.2020v7n1p62 ◽

2020 ◽

Vol 7 (1) ◽

pp. 62-65

Author(s):

Lucas Yago Souza Schmidt ◽

DOWGLAS PEREIRA DE OLIVEIRA ◽

Constância Madami Nzonzi Canda ◽

Ellen Cristina Ferreira Peixoto ◽

Pedro Manuel Gonzalez Cuellar

Keyword(s):

Public Hospital ◽

Abdominal Cavity ◽

Chronic Alcoholism ◽

Fournier’S Gangrene ◽

Protective Measure ◽

Mechanical Trauma ◽

Invasive Procedures ◽

Fournier's Gangrene ◽

Perineal Region ◽

Women And Children

Fournier's Gangrene is a rapidly evolving polymicrobial necrotizing fasciitis of the perineal, perianal, and genital region, extending to the thigh root, abdominal wall and retroperitoneum, which rarely affects women and children, with an overall incidence rate of 1,6 cases per 100,000 men / year and a peak incidence after the age of 50. Incomplete hygiene, exacerbated skin folds, mechanical trauma, prolonged catheterization and invasive procedures, as well as comorbidities such as diabetes mellitus, smoking, obesity, chronic alcoholism, hypertension, immunosuppression, HIV, cancer patients, and chronic diseases are factors that predispose to the appearance of the lesion.The objective of the study is to report the case of a female patient, 43 years old, without comorbidities, with a picture of Fournier's gangrene in the perineal region and genitalia, accompanied by the General Surgery Service of the General Public Hospital of Palmas - TO, and submitted to colostomy in a descending loop as a protective measure of choice for the spread of the infection to the abdominal cavity, interrupting the progression of the disease.

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Clinico-Pathological Profile and Management Outcome of Fournier’s Gangrene in a Tertiary Care Hospital

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v9i2.39208 ◽

2018 ◽

Vol 9 (2) ◽

pp. 124-130

Author(s):

Mahmud Ekram Ullah ◽

Amreen Faruk ◽

Rajibul Haque Talukder ◽

Farukuzzaman ◽

Noor A Alam

Keyword(s):

Tertiary Care ◽

External Genitalia ◽

Fournier’S Gangrene ◽

Care Hospital ◽

Fournier's Gangrene ◽

Predisposing Factor ◽

Medical College ◽

Number Of Patients ◽

Variable Extent ◽

Surgery Department

Background: Fournier’s gangrene is a vascular disaster of infective origin occurring about male external genitalia. Diabetes Mellitus is an important predisposing factor. A good number of patients of this rare clinical entity are admitted frequently in our centre. Till now the disease has the potential for significant morbidity and also mortality.Objective: The study was designed to be conducted among patients suffering from Fournier’s gangrene to identify the possible source of sepsis, to denote pattern and extent of area involvement and microorganisms isolated and to observe the treatment course and outcome.Methods: This prospective observational study was carried out in BIRDEM General Hospital, Dhaka among 60 patients of Fournier’s gangrene admitted under surgery department during the period of October 2016 to January 2018 using purposive sampling method.Result: The results of this study suggest that majority of the study population were in 51 to 60 years (Mean 52±4.9) age group. All the patients were diabetic with grossly elevated blood glucose level (Mean RBS=17.3 mmol/dl). In addition to scrotum, perineum, penis, buttock and lower abdomen were also affected to variable extent (73.3%). All patients required major debridement which had to be repeated in 68.3% cases. Steptococcus pyogens was the most common organism isolated (43.3%) followed by Eschericia coli (35%) and majority were of polymicrobial type (61.6%). Mortality rate was 8.3%.Conclusion: The diagnosis and treatment of Fournier’s gangrene is enigmatic and challenging to the physician. Urgent surgical debridement along with other appropriate supportive measures can reduce morbidity and mortality.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 124-130

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Analysis of prognostic factors affecting mortality in Fournier’s gangrene: A study of 72 cases

Canadian Urological Association Journal ◽

10.5489/cuaj.3192 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 800 ◽

Cited By ~ 8

Author(s):

Mohamed Tarchouli ◽

Ahmed Bounaim ◽

Mohamed Essarghini ◽

Moulay Brahim Ratbi ◽

Mohamed Said Belhamidi ◽

...

Keyword(s):

Prognostic Factors ◽

Mortality Rate ◽

Patient Survival ◽

Length Of Hospital Stay ◽

Severity Index ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Predisposing Factor ◽

Duration Of Symptoms ◽

Factors Affecting

Introduction: Fournier’s gangrene is a rapidly progressing necrotizing fasciitis of the perineum and genital area associated with a high mortality rate. We presented our experience in managing this entity and identified prognostic factors affecting mortality.Methods: We carried out a retrospective study of 72 patients treated for Fournier’s gangrene at our institution between January 2005 and December 2014. Patients were divided into survivors and nonsurvivors and potential prognostic factors were analyzed.Results: Of the 72 patients, 64 were males (89%) and 8 females (11%), with a mean age of 51 years. The most common predisposing factor was diabetes mellitus (38%). The mortality rate was 17% (12 patients died). Statistically significant differences were not found in age, gender, and predisposing factors, except in heart disease (p = 0.038). Individual laboratory parameters significantly correlating with mortality included hemoglobin (p = 0.023), hematocrit (p = 0.019), serum urea (p = 0.009), creatinine (p = 0.042), and potassium (p = 0.026). Severe sepsis on admission and the extent of affected surface area also predicted higher mortality. Others factors, such as duration of symptoms before admission, number of surgical debridement, diverting colostomy and length of hospital stay, did not show significant differences. The median Fournier’s Gangrene Severity Index (FGSI) was significantly higher in non-survivors (p = 0.002).Conclusion: Fournier’s gangrene is a severe surgical emergency requiring early diagnosis and aggressive therapy. Identification of prognostic factors is essential to establish an optimal treatment and to improve outcome. The FGSI is a simple and valid method for predicting disease severity and patient survival.

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Hyperbaric Oxygen Therapy for the Treatment of Fournier’s Gangrene: A Review of 34 Cases

Acta Médica Portuguesa ◽

10.20344/amp.6300 ◽

2015 ◽

Vol 28 (5) ◽

pp. 619 ◽

Cited By ~ 10

Author(s):

Isabel Rosa ◽

Francisco Guerreiro

Keyword(s):

Hyperbaric Oxygen ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Rare Condition ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Predisposing Factor ◽

Source Of Infection ◽

Clinical Records

Introduction: Fournier’s gangrene is a serious necrotizing infection that can be fatal if not promptly attended. Treatment for this condition consists of a combination of surgical debridement, antibiotherapy and supportive care. Hyperbaric oxygen therapy is used as an adjuvant for the optimization of infected tissue oxygenation and for its bactericidal and bacteriostatic effects. Material and Methods: The data presented in this study encompass a period of 25 years of clinical records of patients with Fournier’s gangrene that had been treated at our center with hyperbaric oxygen therapy. Results: A total of 34 patients were treated. The vast majority of patients were males (94.1%) with a mean age of 53.7 years. Urinary tract was the most frequent source of infection and diabetes was most common comorbidity seen in patients. Mortality rate was 20.8%. Discussion: The most common observed comorbidity was diabetes, suggesting diabetes as one predisposing factor. The majority of deceased patients had diabetes, although no significant correlation between diabetes and death was found. The area of residence of patients may affect patients’ referral to these facilities. Conclusions: Although Fournier’s gangrene is a rare condition, it is nevertheless a fatal illness, namely in patients with comorbidities like diabetes. Hyperbaric oxygen therapy is recommended as an adjuvant to conventional therapy and should be considered whenever available. To further assess the role of hyperbaric oxygen therapy, in the treatment of this condition, additional studies should be carried out.

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Fournier's Gangrene: Conventional Dressings versus Dressings with Dakin's Solution

ISRN Urology ◽

10.5402/2012/762340 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Bülent Altunoluk ◽

Sefa Resim ◽

Erkan Efe ◽

Mustafa Eren ◽

Can Benlioglu ◽

...

Keyword(s):

Povidone Iodine ◽

Length Of Hospital Stay ◽

Fournier’S Gangrene ◽

Morbidity And Mortality ◽

Wound Management ◽

Fournier's Gangrene ◽

Group I ◽

The Mean ◽

Group Ii ◽

Destructive Inflammation

Purpose. Fournier’s gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. Methods. Data from 14 patients with Fournier’s gangrene were retrospectively collected (2005–2011). Once the patients were stabilized following surgery, they were treated with either daily antiseptic (povidone iodine) dressings (group I, n=6) or dressings with dakin’s solution (sodium hypochloride) (group II, n=8). Results. The mean age of the patients was 68.2 ± 7.8 (55–75) years in group I and 66.9 ± 10.2 (51–79) years in group II. Length of hospital stay was 13 ± 3.5 (7–16) days in group I and 8.9 ± 3.0 (4–12) days in group II (P<0.05). The number and rate of mortality was 1/6 (16.7%) in group I, and 1/8 (12.5%) in group II. Conclusions. The hospitalization time can be reduced with the use of dakin’s solution for the dressings in the treatment of FG. Also, dressings with dakin’s solution seems to have favorable effects on morbidity and mortality. Consequently dakin’s solution may alter the treatment of this disastrous disease by reducing cost, morbidity and mortality.

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Fournier’s Gangrene in a Patient with Obesity and B-lymphoma

Prague Medical Report ◽

10.14712/23362936.2014.22 ◽

2013 ◽

Vol 114 (3) ◽

pp. 186-190

Author(s):

Christos Komninos ◽

M. Karavitakis ◽

S. Koritsiadis

Keyword(s):

Left Breast ◽

Chemotherapeutic Agents ◽

Clinical Findings ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Predisposing Factor ◽

B Lymphoma ◽

Germinal Center B Cell ◽

Lower Abdominal Quadrant ◽

Abdominal Quadrant

We present a  case of Fournier’s gangrene disease in  a young obese patient with coexistent B-lymphoma. It remains controversial if obesity constitutes a  predisposing factor for an individual to develop necrotizing fasciitis. On the other hand, only few cases of patients with coexistence of B-lymphoma and Fournier’s gangrene disease have been reported. A 30-years-old obese man was admitted to emergency department with fever (38.7 °C), pain, erythema and swelling extended from the left scrotum to the left lower abdominal quadrant. He was confused, with low urinary excretion and septic shock’s signs. The clinical findings were characteristics of Fournier’s gangrene disease. Furthermore during physical examination a  massive, painless and motionless mass in  the left breast was revealed. The patient required urgent surgical debridement of the affected area and pus drainage. Biopsies of the breast mass were received by excision. Pus and blood cultures yielded Staphylococci coagulase(–), Klebsiella and Proteus sp. Intravenous antibiotic treatment with Meropeneme and Clindamycine started immediately. Repeated debridement was often performed. Pathology examination of the massive tissue revealed a  diffuse B-lymphoma of large cells (Germinal center B-cell like-GCB). The patient was discharged from the hospital 35 days later. Afterwards, he was treated with chemotherapeutic agents for malignant lymphoma at the oncological department. The aim of this case’s presentation is to mention that young obese patients with Fournier’s gangrene disease should be particularly investigated due to the possible occurrence of another not obvious predisposing factor, such as a  malignant disease.

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New Methods of Reconstruction for Old Challenges: The Use of the Integra Graft in Necrotizing Soft Tissue Infections of the Male Genitalia

Case Reports in Urology ◽

10.1155/2021/5777235 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Katharina Mitchell ◽

Chad Crigger ◽

Chad Morley ◽

John Barnard ◽

Vidas Dumasius

Keyword(s):

Soft Tissue ◽

Case Series ◽

External Genitalia ◽

Skin Grafting ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Bovine Collagen ◽

Necrotizing Soft Tissue Infections ◽

Perineal Region ◽

Methods Of Reconstruction

In this paper, we describe two cases of Fournier’s gangrene (FG) in which Integra grafting was used for reconstruction. FG is a progressive necrotizing infection occurring in the perineal region and on the external genitalia. Reconstructive options using local tissue are limited due to the destruction this infection imposes on the soft tissue. Integra graft is a bilaminate artificial dermis made of shark chondroitin 6-sulfate and bovine collagen. It is applied to the wound bed after debridement and establishment of a healthy, well-vascularized wound base. The patients in this case series had large defects which could not be closed primarily with tissue beds and would not have been appropriate for skin grafting. Therefore, an Integra graft was placed. In both patients, the wound beds were appropriate for skin grafting after three weeks. Without the Integra graft, both of our patients would have needed to wait a considerable amount of time prior to reconstruction. Our case series further illustrates and supports the use of Integra grafts in such a scenario following Fournier’s gangrene which has only previously been published on three occasions, all of which demonstrated successful outcomes.

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