Fournier's gangrene progressing from the buttocks to the scrotum following a perianal abscess

Experience in management of Fournier's gangrene: a report of 24 cases

Fournier's gangrene (FG) is an extremely aggressive and rapidly progressive polymicrobial soft tissue infection of the perineum, anal area or genitalial regions with a high mortality rate. The objectives of this study were to share our experience with the management of this serious infectious disease over the last 15 years. This retrospective study examined 24 patients diagnosed as having FG who were admitted to our hospital between March 1996 and December 2011. The gender, age, etiology, predisposing factors, laboratory findings, treatment modality, hospitalization time and spread of gangrene of the subjects were all recorded and analyzed. The results showed that the mean age of the patients was 48.33 years, the male-to-female ratio was 5:1 and the mortality rate was 20.8% (5/24). The most common predisposing factor was diabetes mellitus in 10 patients (41.6%), followed by alcohol abuse, obesity, neoplasms and immunosuppression. The most common etiology was peri-anal and peri-rectal abscesses (45.8%), followed by lesions of urogenital origin (33.3%) and cutaneous (8.3%) origin. No local pathologies could be identified in 3 (12.5%) patients. The most commonly isolated microorganisms were Escherichia coli (62.5%), followed by Enterococcus, Pseudomonas aeruginosa and Staphylococcus aureus. The median admission Fournier's gangrene severity index (FGSI) score for survivors was 5.63±1.89 against 13.6±3.64 for non-survivors which was designed for predicting the disease severity in the series. Early diagnosis and immediate extensive surgical debridement were significant prognostic factors in the management of Fournier gangrene. Individualized reconstructive modalities for wound coverage were useful in that they repaired the tissue defect and improved the quality of life. We are led to conclude that Fournier's gangrene is a severe condition with a high mortality. The Fournier's gangrene severity index (FGSI) score at admission serves as a good predictor for the disease severity. Early diagnosis, surgical debridement and aggressive fluid therapy are significant prognostic factors in the management of Fournier gangrene. Individualized reconstructive surgery modalities for wound coverage are useful to correct the tissue defect and improve the quality of life.

Fournier's gangrene syndrome in a chimpanzee (Pan troglodytes)

A 37-yr-old male chimpanzee (Pan troglodytes) was evaluated for intermittent diarrhea, scrotal swelling, and lethargy of 2 days duration. Physical examination revealed marked swelling of the scrotum and perineal tissues with mild pitting edema and crepitus. Computed tomography revealed a mixed gas and soft-tissue density extending from the caudal ventral subcutaneous tissues caudally to the scrotum and perineal tissues. Surgical exploration and castration were performed to establish drainage, and culture revealed a polymicrobial infection. A diagnosis of scrotal and fascial plane abscessation consistent with Fournier's gangrene was made. Although castration with open drainage was performed, the animal died 36 hr after surgery. Postmortem examination and histopathology revealed necrotizing fasciitis of the penis, vaginal tunic, and subcutaneous perineal and perianal tissues.