Fournier’s gangrene in females: A rare entity

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.

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

Case Reports in Surgery ◽

10.1155/2017/2062157 ◽

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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A case of Fournier’s gangrene diagnosed with POCUS

POCUS Journal ◽

10.24908/pocus.v4i1.13314 ◽

2019 ◽

Vol 4 (1) ◽

pp. 3

Author(s):

Marco Badinella Martini, MD ◽

Antonello Iacobucci, MD

Keyword(s):

Type 2 Diabetes ◽

Emergency Department ◽

Alzheimer Disease ◽

Physical Examination ◽

Subcutaneous Emphysema ◽

Vital Signs ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

History Of

An 87-year-old man with a history of type 2 diabetes and severe Alzheimer disease was admitted to the emergency department with a lesion of the perineum for two days. The patient appeared agitated and not collaborating on the visit. His vital signs were normal. Physical examination revealed an edematous, suppurative, and foul-smelling perineal-scrotal lesion, with possible subcutaneous emphysema.

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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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Fournier’S Gangrene Caused byListeria Monocytogenesas the Primary Organism

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2015/501386 ◽

2015 ◽

Vol 26 (1) ◽

pp. 44-46 ◽

Cited By ~ 3

Author(s):

Sayaka Asahata ◽

Yuji Hirai ◽

Yusuke Ainoda ◽

Takahiro Fujita ◽

Yumiko Okada ◽

...

Keyword(s):

Tongue Cancer ◽

Rectal Adenocarcinoma ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Daily Consumption ◽

Travel History ◽

Direct Invasion ◽

History Of ◽

Raw Fish ◽

Serotype 4B

A 70-year-old man with a history of tongue cancer presented with Fournier’s gangrene caused byListeria monocytogenesserotype 4b. Surgical debridement revealed undiagnosed rectal adenocarcinoma. The patient did not have an apparent dietary or travel history but reported daily consumption of sashimi (raw fish).Old age and immunodeficiency due to rectal adenocarcinoma may have supported the direct invasion ofL monocytogenesfrom the tumour. The present article describes the first reported case of Fournier’s gangrene caused byL monocytogenes. The authors suggest that raw ready-to-eat seafood consumption be recognized as a risk factor for listeriosis, especially in cases of skin and soft tissue infection.

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Coexistence of human immuno deficiency virus, diabetes mellitus, epididymal cysts, and Fournier's gangrene: A case report

Journal of Experimental and Clinical Medicine ◽

10.52142/omujecm.38.4.45 ◽

2021 ◽

Vol 38 (4) ◽

pp. 669-671

Author(s):

Evrim KAR ◽

Hatice Şeyma AKÇA ◽

Serdar ÖZDEMİR ◽

Abdullah ALGIN ◽

Serkan Emre EROĞLU

Keyword(s):

Case Report ◽

Subcutaneous Tissue ◽

Fournier’S Gangrene ◽

Clinical Suspicion ◽

Perianal Region ◽

Fournier's Gangrene ◽

Human Immuno Deficiency Virus ◽

Immunodeficiency Virus ◽

History Of ◽

Artery Disease

Fournier's gangrene (FG) is a form of necrotizing fasciitis that is localized in the external genital organs and perianal region and causes skin and subcutaneous tissue gangrene. The clinical picture may vary depending on the patient's comorbidities and the extent of infection; Many predisposing conditions such as immunodeficiency, diabetes, alcoholism encourage the spread of the infection. In this case report, we highlighted the importance of emergency debridement in patients with multiple comorbidities by presenting the Fournier's Gangrene case in a 57-year-old immunosuppressive male patient with cystic lesions in the epididymis, with a history of hypertension, coronary artery disease, diabetes, HIV (human immunodeficiency virus) and a history of bipolar disorder. The patient, who was operated on for debridement by the urology, was given 1x500mg daptomycin, 3x1g meropenem, 3x450mg clindamycin IV treatment. The patient was discharged with full recovery after 17 days of hospitalization. Clinical suspicion in Fournier's gangrene cases, early surgical debridement, and extended-spectrum anti biotherapy are important. with rapid diagnosis and treatment in patients with improvement can also be seen in patients with comorbidities.

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Outcome management of Fournier’s gangrene cases at tertiary hospital: 7 Years experience

Urologia Journal ◽

10.1177/03915603211046483 ◽

2021 ◽

pp. 039156032110464

Author(s):

Soetojo Wirjopranoto ◽

Yufi Aulia Azmi

Keyword(s):

General Hospital ◽

Severity Index ◽

The Elderly ◽

Tertiary Hospital ◽

Fournier’S Gangrene ◽

Fournier's Gangrene ◽

Management Culture ◽

Outcome Management ◽

History Of ◽

Analytic Design

Objective: This study aims to describe the condition of Fournier’s gangrene in Dr. Soetomo General Hospital from January 2014 to December 2020. Material and methods: This study used a retrospective analytic design, by taking data through medical records at Dr. Soetomo General Hospital from January 2014 to December 2020. This study used total sampling with recorded data: age, gender, length of stay, outcome, location, comorbidities, causes, management, culture results, and Fournier’s gangrene severity index (FGSI) score. Result: Of the 135 subjects collected, it was found that 55.56% were individuals over 50 years of age. About 91.11% were male patients, with some sites being in the scrotum 50.37%. Only 25.19% of patients had no comorbids, while the rest had a history of CKD, hypertension, diabetes, or a combination of these diseases. Bacterial cultures obtained were mostly caused by the Enterobacteriaceae bacteria group (32.59%). Of the subjects we studied who experienced mortality, it was found that all were from the group with FGSI >9. Conclusion: From the results of our descriptive study, at a glance, it appears that there is a tendency for the incidence of Fournier’s gangrene in the elderly and individuals with comorbidities. And the mortality rate increases with a high FGSI value. So that FGSI could be used as a predictor of mortality in patients with FG.

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Perforated appendicitis as a source of Fournier’s gangrene in an immunocompetent male

International Surgery Journal ◽

10.18203/2349-2902.isj20194446 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3813

Author(s):

Nasser Alzerwi Alzerwi ◽

Mohammed Alshanwani ◽

Afnan Sultan Alsultan ◽

Sulaiman Almutairi ◽

Yasser Ibrahim Aldebasi ◽

...

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Perforated Appendicitis ◽

Rare Condition ◽

Immunocompetent Patient ◽

Fournier’S Gangrene ◽

Critical Importance ◽

Fournier's Gangrene ◽

History Of ◽

Scrotal Swelling

Fournier’s gangrene is a synergetic polymicrobial necrotizing fasciitis of the perianal, perineal and genital areas, it is a rare condition and it has a high mortality rate of up to 67%. Acute appendicitis has been identified as another cause of Fournier’s gangrene. This case demonstrates the critical importance of considering a diagnosis of Fournier’s gangrene because of a missing diagnosis of appendicitis even if the patient is young, healthy, immunocompetent and without a background of abdominal pain. We discuss a case of 35-year-old male, immunocompetent and medically free, who was presented to Emergency Department with a clinical picture of Fournier’s gangrene due to acute perforated appendicitis without a history of abdominal pain, and within 48 hours of the onset of bilateral scrotal swelling. Our case demonstrates the importance of considering Fournier’s gangrene as a complication of an intra-abdominal septic process, even in a young, healthy, immunocompetent patient.

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