Abstract

"Purpose: Fournier's gangrene is aggressive necrotizing fasciitis of the scrotum, penis or perineum with a fatal synergistic polymicrobial infection. we evaluated the clinical outcome and management of patients with Fournier's gangrene. Material and Methods: Total of 23 cases of Fournier's gangrene treated in our hospital during the last 20 years were evaluated retrospectively through medical records such as onset season, department and diagnosis at first visit, time to diagnosis, laboratory finding, co-existing disease, prodromal symptom, hospital stay, treatment methods and outcome. Results: The patients' ages ranged between 39 and 83 years old (mean 63.2). There was no relation between onset of Fournier's gangrene and onset season. The usual prodromal symptoms were lower abdominal and inguinal pain. The co-existing disease included diabetes mellitus (9 cases, 34.7%), chronic liver disease (2 cases, 7.7%), pulmonary tuberculosis (2 cases, 7.7%), hemorrhoid (2 cases, 7.7%), debility (2 cases, 7.7%), paraplegia (1 case, 3.8%), malignant disease (1 case, 3.8%), urethral stricture (1 case, 3.8%) and hypertension (1 case, 3.8%). Contributing factors to establish infection were traumatic injury, urethral catheterization, hemorroid and peritonitis for 3, 2, 2 and 1 patients, respectively. Accuracy of diagnosis at the first visit was 81.3% in urologic, and 14.3% in non-urologic departments. Single and multiple infection were occurred in 16 (76.2%) and 5 (23.8%) patients, respectively, and E. Coli was most common causative microorganism. In the laboratory tests, leukocytosis (mean WBC: 13.1×103/ul), hypoalbuminemia (mean albumin: 2.6mg/dl) and increase of C-reactive protein (mean CRP: 16.4mg/dl) were characteristic. All patients were treated with triple broad spectrum antibiotics with wide surgical debridement. Cysotstomy and colostomy were additionally done in 13 (56.5%) and 5 (21.7%) patients, respectively. There was no death after final management. Conclusion: Early diagnosis and aggressive treatment with empirical triple antibiotics and wide debridment of devitalized tissue can reduce the mortality and bring a good outcome."

• Keywords: Fournier';s gangrene, Management, Clinical outcome