Evaluation of Risk Factors and Severity of a Life Threatening Surgical Emergency : Fournier's Gangrene (A Report of 15 Cases)
No Thumbnail Available
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background : Fournier's gangrene is a rare, rapidly progressive, necrotising fasciitis of the external genitalia and perineum with high morbidity and mortality. Patients & Methods : 15 patients with Fournier's gangrene were enrolled. Gender, age, aetiology, predisposing factors, symptomatology, associated diseases, hospital stay, FGSI, and body surface area were analysed. Results : Ten males and five females were enrolled in the study. The mean age was 54 years (range 23-81). E.coli and acinetobacter were the common organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. Common predisposing factors included diabetes mellitus (73.3%), poor personal hygiene (60%), obesity (33.3%), psychosis (20%) and decubitus ulcers (13.2%). Whereas five (33.3%) patients developed synergistic gangrene of the scrotum secondary to anorectal disease, five (33.3%) had a urological source of infection. Mean BSA and FSGI scores were 15.93 +/- 3.13 and 6.02 +/- 0.95, respectively. Serum glucose > 140 mg/dl, the existence of septic shock on admission, the spread of gangrene to the perineum and abdominal wall (Groups C and D), BSA >= 24 cm(2), a cutaneous source of infection and FGSI scores >= 7 were factors affecting mortality rates with statistical significance (p < 0.05). There was a direct correlation between the culture of mixed type micro-organisms and the cutaneous source of infection (p < 0.05). The extent of gangrene correlated with higher FGSI scores (7) (p < 0.05). Mortality and morbidity rates were as 20% (n=3) and 60% (n= 9). Conclusion : Aggressive surgical debridement and combined antibiotherapy are essential in the management of Fournier's gangrene. FGSI and BSA are useful to assess the severity and prognosis of the disease.