PROTETIVE COLOSTOMY IN FOURNIER’S GANGRENE

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.

scholarly journals Algorithm of rational approach to reconstruction in Fournier’s disease

Open Medicine ◽  
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.

scholarly journals A clinical study of Fournier’s gangrene and use of honey dressing in treatment

2018 ◽  
Vol 6 (3) ◽  
pp. 932
Author(s):  
Subodh P. Ugane ◽  
Shrikant K. Kalbagwar ◽  
Sanjot B. Kurane
Keyword(s):  
Chronic Alcoholism ◽  
Fournier’S Gangrene ◽  
Hiv Positive ◽  
Fournier's Gangrene ◽  
Coagulase Negative Staphylococci ◽  
Lower Socioeconomic ◽  
Initial Symptoms ◽  
Male Patients ◽  
Dressing Materials ◽  
Small Work

Abstract- backgroundFournier’s gangrene is necrotizing fasciitis involving genitals and perineal regions.  Fournier’s gangrene is a surgical emergency. If not treated immediately it spreads rapidly causing septicemia leading to death. Mainstay of treatment is surgical and regular dressing. Various dressing materials are available like eusol,  in our study we use Honey as dressing material. This is a small work to attempt to study incidence, etiology and pathogenesis and use of dressing for the treatment of Fournier’s Gangrene.Materials and methods in our study we study 40 male patients of Fournier’s gangrene. We studied clinico- pathology of disease and use of honey dressing for the management of Fournier’s gangrene. Out of 40 patients 18 were treated with honey as dressing material and remaining 22 with eusol.Results- 40 patients were admitted and majority of patients were in age group > 60 years mean age was 54.08 _ 15.47 years. Majority of patients belonged to lower socioeconomic class 82.5%. Most of patients presented in hospital within 7 days of initial symptoms. In this study etiological causes found in 85% of patients and among which most common were urogenital causes 32.5%. Majority of patients had chronic alcoholism and bad hygiene as predisposing factors. 25% were associated with diabetes mellitus. In this study 12% of patients were HIV positive. Most common organism found in pus culture was E.coli (42.5%) followed by Coagulase negative Staphylococci in 32.5%, Klebsiella in 12.5%, Pseudomonas in 7.5% and no organism were isolated in 5%.Mean days required for healthy granulation by honey dressing was 9.62+- 4.5 days and for eusol was 10.5 +- 3.79 days. In our study mortality was 22.5%.

scholarly journals Iatrogenic rectal injury associated with fleet enema administration masquerading as Fournier’s Gangrene

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
Yi Liang ◽  
Angelina Di Re ◽  
Grahame Ctercteko
Keyword(s):  
Perineal Wound ◽  
Fournier’S Gangrene ◽  
Mechanical Trauma ◽  
Rectal Injury ◽  
Fournier's Gangrene ◽  
Current Case ◽  
Affected Tissue ◽  
Life Threatening ◽  
Extensive Debridement ◽  
Mucosal Necrosis

Abstract Rectal injuries secondary to fleet enemas are the result of a chemical irritation as well as mechanical trauma causing localized perforation and mucosal necrosis. These injuries can be managed expectantly. Fournier’s Gangrene is a life-threatening, fulminant soft tissue infection of the genito-perineal region commonly secondary to a perianal infection, requiring extensive debridement of all affected tissue and judicious antibiotic therapy. This distinction is critical in the management of the current case, allowing for limited debridement and judicious observation without a resection of the injured rectum. A diverting colostomy allows for effective faecal management and minimizes contamination of the perineal wound.

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

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.

Fournier’s Gangrene after Bilateral Vasectomy-A Case Report

2020 ◽  
Vol 5 (2) ◽  
pp. 1122-1125
Author(s):  
Aabishkar Bhattarai ◽  
Bijaya Karki ◽  
Pragya Bhandari
Keyword(s):  
Male Partner ◽  
Anaerobic Bacteria ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Steroid Use ◽  
Permanent Contraception ◽  
Women And Children ◽  
Common Risk Factors ◽  
The Common

Fournier’s gangrene is an acute, rapidly progressing, potentially fatal necrotizing fasciitis affectingthe external genitalia, perineal or perianal regions and is caused by a mixed infection with aerobic/anaerobic bacteria, which commonly affects the men, but can also occur in women and children. The most common foci of infection are from gastrointestinal tract, genitourinary tract or less commonly from the cutaneous injuries. The common risk factors includediabetes mellitus,alcohol abuse, extremes of age, male gender, chronic steroid use, malnutrition and immunosuppression. Uncommonly, Fournier’s gangrene has been documented after vasectomy operation-a permanent technique for male partner sterilization. Here we present a case of Fournier’s gangrene in an adult male who had undergone bilateral standard vasectomy for permanent contraception and presenting after 7 days with gangrene in the scrotum requiring urgent debridement and broad-spectrum antibiotics.

scholarly journals Experience of Fournier’s gangrene clinical diagnostics

2016 ◽  
Vol 97 (1) ◽  
pp. 159-162
Author(s):  
A V Prokhorov
Keyword(s):  
Ultrasound Examination ◽  
Abdominal Cavity ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Plain Radiography ◽  
Clinical Diagnostics ◽  
Urogenital System ◽  
Anorectal Abscess ◽  
Fournier's Gangrene ◽  
Presumptive Diagnosis

The article represents clinical cases review of rare and serious disease - Fournier’s gangrene. 3 patients with Fournier’s gangrene aged 53±13 years were followed up in Moscow City Clinical Urological Hospital №47 and City Clinical Hospital №57 in the period from 2005 to 2015. All patients with Fournier’s gangrene were admitted to the hospital with a different referral diagnoses: «acute epididymo-orchitis», «testicular abscess», «scrotal phlegmon». Standard clinical and laboratory tests, abdominal cavity and urogenital system plain radiography and ultrasound examination were performed. For genital organs ultrasound examination a high-resolution linear transducer (6-16 MHz) was used. Ultrasonography in the admission room allowed to exclude acute scrotal diseases in all patients, Fournier’s gangrene was diagnosed in 2 patients, and suspected in 1 patient. In all patients with Fournier’s gangrene ultrasound examination revealed marked thickening of testicular coats (more than 15 mm), the accumulation of a small amount of fluid between the testicular coats and in the tunica vaginalis cavity, testicular coats intense hypervascularization; normal blood flow and the unchanged structure of the testes and epididymis. Scrotal emphysema was detected by ultrasound examination in all patients, by the plain radiography and physical examination - in 2 patients. In all cases, ultrasound helped to clarify the cause of Fournier’s gangrene: to reveal anorectal abscesses, acute prostatovesiculitis and exclude acute epididymo-orchitis, scrotal phlegmon and testicular injury. As an illustration Fournier’s gangrene observation, which occurred as an anorectal abscess complication is presented. Ultrasonography allows to confirm the Fournier’s gangrene presumptive diagnosis (to reveal soft tissue of the penis and scrotum emphysema), make differential diagnosis of Fournier’s gangrene with other external genitalia and perianal area acute diseases, determine treatment strategy.

scholarly journals Fournier’s gangrene: a clinical profile of 30 cases

2018 ◽  
Vol 5 (3) ◽  
pp. 1062
Author(s):  
Kavya T. ◽  
Rajashekara Babu G. ◽  
Santhosh C. S.
Keyword(s):  
Multimodality Treatment ◽  
Good Prognosis ◽  
Fournier’S Gangrene ◽  
Morbidity And Mortality ◽  
Fournier's Gangrene ◽  
Predisposing Factor ◽  
Common Etiology ◽  
Perineal Region ◽  
Aggressive Debridement ◽  
The Impact

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.

scholarly journals Fournier’s gangrene in females: A rare entity

2021 ◽  
pp. 348-350
Author(s):  
A Prem Kumar ◽  
Sandesh Gopalakrishnan Nair
Keyword(s):  
Abrupt Onset ◽  
Fournier’S Gangrene ◽  
Purulent Discharge ◽  
Deep Fascia ◽  
Fournier's Gangrene ◽  
Urogenital Infections ◽  
History Of ◽  
Necrotizing Fascitis ◽  
Perineal Region ◽  
History Of Pain

Fournier’s gangrene is a form of necrotizing fascitis with abrupt onset of rapidly fulminating genital gangrene of idiopathic origin and gangrene up to deep fascia. It occurs usually in patients with urogenital infections and comorbidities such as diabetes, immunosuppression, or even trauma. Here, we present one such case of an 86-year-old female presenting with a history of pain and purulent discharge from the perianal region for 5 days. On examination, a wound of 20 × 15 cm perineal region extending up to the gluteal region posteriorly and labia majora anteriorly. The patient was planned for debridement under spinal anesthesia on an emergency basis followed by regular dressing and antibiotic therapy. The peri-operative period was uneventful. Along with surgical management, the patient was managed medically by control of sugars, treating sepsis with appropriate antibiotics. The patient recovered from sepsis, and the wound showed granulation tissue after 1 week of serial debridement. The wound was closed with a skin graft at a later date. Fournier’s gangrene should be kept as a differential diagnosis in females with perineal abscesses or necrotizing fascitis in females.

Fournier's gangrene as Amyand's hernia complication

2019 ◽  
Vol 98 (7) ◽  
pp. 291-296
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Rare Condition ◽  
Sporadic Case ◽  
Fournier’S Gangrene ◽  
Amyand’S Hernia ◽  
Fournier's Gangrene ◽  
Randomized Controlled Studies ◽  
Based Medicine ◽  
Hernia Complication

Introduction: Fournier’s gangrene is a rare but fast deteriorating and serious condition with high mortality. In most cases, it is characterized as necrotizing fasciitis of the perineum and external genitals. Amyand’s hernia is a rare condition where the appendix is contained in the sac of an inguinal hernia. Inflammatory alterations in the appendix account only for 0.1 % of the cases when Amyand’s hernia is verified. Fournier’s gangrene as a complication of a late diagnosis of appendicitis located in the inguinal canal is described in the literature as rare case reports. Case report: The case report of a 70-year-old patient with Fournier’s gangrene resulting from gangrenous appendicitis of Amyand’s hernia. Conclusion: Fournier’s gangrene as a complication of Amyand’s hernia is a rare condition. Only sporadic case reports thereof can be found in the literature. Because of the rarity of this pathology and the lack of randomized controlled studies, it is difficult to determine the optimal treatment according to the principles of evidence-based medicine. An appropriate approach for this condition appears to be the combination of guidelines developed in Amyand’s therapy according to Losanoff and Basson, along with the recommended “gold standard” therapy for Fournier’s gangrene. This means early and highly radical surgical debridement, adequate antibiotic therapy and intensive care.

Fournier’s gangrene due to Salmonella Typhimurium in a healthy male: a rare aberrant infection

2020 ◽  
Vol 20 ◽  
Author(s):  
Varsha Gupta ◽  
Lipika Singhal ◽  
Kritika Pal ◽  
Mani Bhushan ◽  
Rajeev Sharma ◽  
...  
Keyword(s):  
Salmonella Typhimurium ◽  
Systemic Disease ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
The Body ◽  
Healthy Male ◽  
Fournier's Gangrene ◽  
Salmonella Infections ◽  
Chief Complaints ◽  
Human Infections

Introduction: Human Salmonella infections have been classically distinguised into diseases caused by typhoidal and non-typhoidal salmonella (NTS). Typhiodal salmonella includes S. enterica serovars Typhi and Paratyphi that cause the systemic disease but are restricted to human infections, while NTS consists mainly of other serovars that predominantly cause self-limiting gastroenteritis in humans. Localisation of foci with persisting infection occurs due to dissemination of the bacteria throughout the body and can cause a variety of rare clinical syndromes at aberrant sites. Fournier’s gangrene, a rapidly progressive, often fatal, necrotizing fasciitis of the external genitalia and perineum due to Salmonella Typhimurium, is a rare manifestation and has never been reported. Case: A 22-year-old male, apparently healthy patient with no relevant past medical history presented to surgical emergency with chief complaints of swelling of bilateral scrotal area. Infective etiology was considered and a diagnosis of fournier’s gangrene was made. Pure growth of Salmonella Typhimurium was obtained after repeated subculture and was identified biochemically and on serotyping, as Salmonella enterica serotype Typhimurium using specific antisera. Conclusion: In our case report, we describe a case of fournier’s gangrene due to Salmonella Typhimurium in an otherwise healthy male to highlight the unusual presentation of Non typhoidal salmonellae at an aberrant site. We also emphasize the importance of using selective media like Selenite F broth for isolation of Salmonella Typhimurium from a pus sample.

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