Gangrena de Fournier. Reporte de caso

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.

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

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.

scholarly journals A CASE STUDY ON FOURNIER’S GANGRENE IN AN EPILEPTIC PATIENT WITH THE EMERGENCE OF ANTIBIOTIC RESISTANCE IN BACTERIA

2020 ◽  
pp. 88-90
Author(s):  
SOWJANYA MENDEM ◽  
MD AQIB ALI FARAZ ◽  
K. LANKESWAR RAO
Keyword(s):  
Broad Spectrum ◽  
Epileptic Patient ◽  
Fournier’S Gangrene ◽  
Necrotic Tissue ◽  
Fournier's Gangrene ◽  
Broad Spectrum Antibiotic ◽  
Necrotizing Soft Tissue Infection ◽  
The Mean ◽  
High Doses

Fournier's gangrene is rare necrotizing soft tissue infection affecting the perianal, perineal, and genital areas. The mean age of the reported cases was found to be at 55 y, predominantly in men. It occurs due to insufficient blood supply to the affected areas, along with the presence of an infection. Delay in the treatment is associated with a higher mortality rate, up to 90%, as the condition might progress to septic shock and other complications. Treatment requires urgent surgical debridement of all the necrotic tissue along with high doses of broad-spectrum antibiotics. Empirical broad-spectrum antibiotic therapy is to be initiated as soon as possible until the results of the culture cause modifications in the therapy.

scholarly journals CLINICAL STUDY ON FOURNIER'S GANGRENE

2020 ◽  
pp. 1-2
Author(s):  
Y. Sarath Chandu ◽  
Y. Sree Krishnudu
Keyword(s):  
Clinical Study ◽  
Mortality Rate ◽  
Necrotizing Fasciitis ◽  
High Mortality ◽  
External Genitalia ◽  
Fournier’S Gangrene ◽  
Predisposing Factors ◽  
Fournier's Gangrene ◽  
Fatal Course ◽  
Surgical Conditions

Fournier's gangrene is a surgical emergency with a high mortality rate. Fournier's gangrene (FG) is an acute, rapidly progressive, and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions, which commonly affects men, but can also occur in women and children1. Although Jean Alfred gave this condition its eponymous name in 1883, it was first described by Baurienne2 in 1764. FG is relatively rare, with an estimated overall incidence of 1.6/100000 males3. Many patients with Fournier's gangrene have either medical or surgical conditions, which are the predisposing factors to FG or its more severe or fatal course.

scholarly journals PREDISOPSING FACTORS; MANAGMENT AND OUTCOMES OF NECROTIZING FASCITIS Among patients who admitted to surgical ward at Al-Thawra hospital; January 2020 to January 2021: العوامل المسببة؛ إدارة ونتائج التفتت الناخر؛ لدى عينة من المرضى في قسم الجراحة بمستشفى الثورة بصنعاء

2021 ◽  
Vol 5 (3) ◽  
pp. 118-99
Author(s):  
Yasser Abdurabo Obadiel, Mohammed Hamood Alyan Yasser Abdurabo Obadiel, Mohammed Hamood Alyan
Keyword(s):  
Mortality Rate ◽  
Necrotizing Fasciitis ◽  
Soft Tissues ◽  
Perianal Abscess ◽  
Deep Fascia ◽  
Surgical Department ◽  
Incidence And Mortality ◽  
Threatening Condition ◽  
Life Threatening ◽  
Necrotizing Fascitis

  Background: Necrotizing fasciitis is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia. It’s a fatal infection with high mortality if treatment delayed. Early diagnosis, surgical debridement and broad-spectrum antibiotic therapy are the optimal treatments to reduce the mortality. Objective: The aims were to identify risk factors for Necrotizing fasciitis and to describe the outcome of management. Methods: A prospective descriptive study was conduted at AL-THAWRA HOSIPTAL located in Sana’a, Yemen. All medical records of patients with confirmed NF who admitted to surgical department between January 2020 and January 2021 were reviewed. Results: The study enrolled 54 patients diagnosed with Necrotizing fasciitis. Male patients were 43 patients (79.6%) and female patients were 11 patients (20.3%). The age rang was 9 – 75 years old and the peak age incidence was at 46–60 years (33.3%). The incidence of NF increases with aging, male gander (79.6%), in comorbid patients (64.9%) especially DM (37%). The etiologies of NF were trauma in (16.6%) and perianal abscess in (14.8%), but (27.7%) of NF patients hadn’t specific cause. The defected wound was treated by skin graft in (32.5%) and primary closure in (27.5%). The mortality rate was (27.7% n=15); (60%) of them died on first 5 days. Septic shock was the reason of death in (73.2%). The higher mortality rate was seen at male gander (66.6%), age group > 60 years (46.6%), in patients who presented in shocked state (73.3%) and in comorbid patients (73.3%). Conclusion: Necrotizing fasciitis represents a life threatening condition with challenges in diagnosis. Incidence and mortality of NF are common in male gander, an elderly patient, or in who suffers of comorbidities; especially DM.

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.

MICROBIOLOGICAL PROFILE, ANTIBIOTIC SENSITIVITY AND PROGNOSIS OF PATIENTS WITH FOURNIER’S GANGRENE: A PROSPECTIVE, HOSPITAL BASED STUDY FROM NORTH INDIA

2021 ◽  
pp. 78-80
Author(s):  
Sanjay Gupta ◽  
Ajay Kumar ◽  
Adiveeth Deb
Keyword(s):  
Mortality Rate ◽  
Acinetobacter Baumannii ◽  
Ventilatory Support ◽  
Antibiotic Sensitivity ◽  
Fournier’S Gangrene ◽  
North India ◽  
Klebsiella Pneumonia ◽  
Bacterial Strains ◽  
Perianal Region ◽  
Fournier's Gangrene

Background: Fournier's gangrene (FG) is a devastating disease that is characterized by necrotizing fasciitis of the perineal, genital, or perianal region. Broad-spectrum antibiotics are the key component of its treatment. However, there is paucity of data regarding the optimal empirical antibiotic therapy for FG. Materials and Methods: Data from patients who underwent surgery for FG was retrieved from a prospectively collected departmental FG database. Demographics, clinical characteristics, causative pathogens and drug susceptibility/resistance were evaluated. Outcome was also assessed in terms of mortality. Results: Fifty patients with a median age of 58.5 (40-83) years were included. The perianal region and scrotum (88%) were the most commonly affected. Diabetes mellitus (DM) was the most common comorbidity (92%). The median time to onset of symptoms was 7 (2-15) days, and the median duration of hospital stay was 22 (4-65) days. Ventilator requirement was required in 15 (30%) patients. The median UFGSI score was 9.5 (3-15). The overall mortality rate was 26%. A positive growth was found in specimen cultures of 48 (96%) patients. The median number of bacterial strains that grew in the cultures was 3 (0-10). Amikacin was the antibiotic with the highest frequency of sensitivity (74%), while the highest resistance was observed against ampicillin-sulbactam (64%). Escherichia coli was the most common microorganism (68%). Acinetobacter baumannii and Klebsiella pneumonia were signicantly more common in patients who required mechanical ventilation. The mortality rate was 26%. An Uludag Fournier's Gangrene Severity Index (UFGSI) score of > 9.5 and ventilatory support requirement were factors associated with an increased rate of mortality. Acinetobacter baumannii was the only microorganism which was associated with an increased mortality rate. Conclusion: Causative pathogens in FG appeared to be shifting; thus, empirical antibiotic treatment for this disease should be modied. We recommend 3rd-generation cephalosporin, metronidazole and amikacin for empirical therapy.

Fournier's gangrene: Report on two cases

1997 ◽  
Vol 64 (2) ◽  
pp. 266-268
Author(s):  
F. Laganà ◽  
E. Cossaro ◽  
C. Ronconi ◽  
F. Sercia ◽  
M. Marchini
Keyword(s):  
Mortality Rate ◽  
Chronic Diseases ◽  
High Mortality ◽  
Hyperbaric Oxygenation ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene ◽  
Tissue Ischemia ◽  
First Choice

– Fournier's gangrene is a rare pathology that generally occurs in weakened patients with chronic diseases, like diabetes, which imply tissue ischemia and even today a high mortality rate. Two cases are presented, one of which is interesting for its pathogenesis. The authors confirm that first choice treatment should be surgical associated with antiobiotics and hyperbaric oxygenation whenever possible.

Retroperitoneal necrotizing fasciitis secondary to Fournier’s gangrene

2015 ◽  
Vol 47 (5) ◽  
pp. 271-273 ◽  
Author(s):  
E. Sebastian-Valverde ◽  
C. Pañella-Vilamú ◽  
E. Membrilla-Fernández ◽  
J. J. Sancho-Insenser ◽  
L. Grande-Posa
Keyword(s):  
Necrotizing Fasciitis ◽  
Fournier’S Gangrene ◽  
Fournier's Gangrene

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

2015 ◽  
Vol 9 (11-12) ◽  
pp. 800 ◽  
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.

scholarly journals Treatment of Complete Anal Stricture after Diverting Colostomy for Fournier’s Gangrene

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Kenji Okumura ◽  
Tadao Kubota ◽  
Kazuhiro Nishida ◽  
Alan Kawarai Lefor ◽  
Ken Mizokami
Keyword(s):  
Soft Tissues ◽  
Fournier’S Gangrene ◽  
Colostomy Closure ◽  
Anal Stenosis ◽  
Fournier's Gangrene ◽  
Anal Stricture ◽  
Internal Hemorrhoids ◽  
Old Japanese ◽  
History Of ◽  
Diverting Colostomy

Background. Anal stenosis is a rare but serious complication of anorectal surgery. Severe anal stenosis is a challenging condition. Case Presentation. A 70-year-old Japanese man presented with a ten-hour history of continuous anal pain due to incarcerated hemorrhoids. He had a history of reducible internal hemorrhoids and was followed for 10 years. He had a fever and nonreducible internal hemorrhoids surrounding necrotic soft tissues. He was diagnosed as Fournier’s gangrene and treated with debridement and diverting colostomy. He needed temporary continuous renal replacement therapy and was discharged on postoperative day 39. After four months, severe anal stenosis was found on physical examination, and total colonoscopy showed a complete anal stricture. The patient was brought to the operating room and underwent colostomy closure and anoplasty. He recovered without any complications. Conclusion. We present a first patient with a complete anal stricture after diverting colostomy treated with anoplasty and stoma closure. This case reminds us of the assessment of distal bowel conduit and might suggest that anoplasty might be considered in the success of the colostomy closure.

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