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Alasker A, Almasari RW, Alhaidar A, Alajmi AF, Alsaleh RK, Aloufi A. Early Diagnosis and Treatment Outcomes of Fournier Gangrene in a Tertiary Center. Cureus 2024; 16:e63815. [PMID: 39099984 PMCID: PMC11297521 DOI: 10.7759/cureus.63815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION Fournier gangrene is an uncommon urological emergency caused by microbial agents, resulting in necrosis of the genitalia and perineum. This study aims to evaluate the outcomes of early diagnosis and management of Fournier gangrene at KAMC in Riyadh, Saudi Arabia. METHODS A retrospective cohort study was conducted at KAMC, Saudi Arabia. The study population included all adult patients diagnosed with Fournier gangrene between 2015 and 2022. Data analysis was performed using RStudio (RStudio, Boston, MA). Frequencies and percentages were used to present categorical data, while medians and interquartile ranges were used to express numerical variables. RESULTS The study included 41 patients with Fournier gangrene, the majority (95.12%) being male with a median age of 60 years. The most prevalent comorbidity was diabetes mellitus (85.37%). Ten patients presented to the hospital with sepsis, two of whom were in shock. Within 90 days of admission, two of them had expired. This resulted in a 20% mortality rate among septic patients. The mean FGSI in patients who had died during hospital stays was approximately two times the mean in surviving patients (8.17 and 4.32, respectively). The most utilized imaging study was a CT scan (70.7%). Most patients had undergone multiple debridements (87.7%). The median number of debridements per patient was three, and the interval between each debridement was three days. The most frequent tissue culture finding was mixed organisms, followed by Escherichia coli. Regarding empiric antibiotics, tazocin was the most used, accounting for 22.0%. The most frequently performed adjunctive procedure was the placement of a suprapubic catheter, accounting for 41.5%. Roughly 43.90% required a blood transfusion. Within 90 days of admission, six patients had died, which makes the mortality rate 14.6%. Four of them had died within 30 days of admission (9.76%). CONCLUSION Fournier gangrene is a surgical emergency that requires prompt attention and resuscitation, antibiotic therapy, and surgical debridement. The study identified the demographic factors of patients who presented with the disease and provided the incidence, mortality rate, and outcomes of the disease. It also identified specifics of the pharmacological and surgical management and hospital courses.
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Affiliation(s)
- Ahmed Alasker
- Division of Urology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rayan W Almasari
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Abdullah Alhaidar
- Division of Urology, King Abdulaziz Medical City Riyadh, Riyadh, SAU
- Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Abdulaziz F Alajmi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Rayan K Alsaleh
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Ammar Aloufi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Medicine, King Abdullah International Medical Research Center, Riyadh, SAU
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Alhubaishy B, Bahassan OM, Alsabban AE, Alkhzaim AH, Alnefaie ZA, Algarni KS, Almehmadi SG, Alqahtani SN. Variables that predict hospital stay and the outcome of Fournier gangrene at King Abdulaziz University Hospital: a retrospective study. BMC Urol 2024; 24:107. [PMID: 38755621 PMCID: PMC11097444 DOI: 10.1186/s12894-024-01496-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The aggressive nature of Fournier gangrene and the associated health issues can result in a more complex clinical course and potentially a longer hospital stay. This study aimed to assess factors that affect the length of hospital stay (LHS) and its relation to the outcome of Fournier gangrene patients. METHODS A retrospective study was performed at King Abdulaziz University Hospital (KAUH), Saudi Arabia, on patients diagnosed with Fournier gangrene between 2017 and 2023. Data about length of hospital stay (LHS), age, BMI, clinical and surgical data and outcome was obtained. RESULTS The mean age of the studied patients was 59.23 ± 11.19 years, the mean body mass index (BMI) was 26.69 ± 7.99 kg/m2, and the mean duration of symptoms was 10.27 ± 9.16 days. The most common presenting symptoms were swelling or induration (64%), 88% had comorbidities with diabetes mellitus (DM) (84%), and 76% had uncontrolled DM. of patients, 24% had a poly-microbial infection, with E. coli being the most common (52%). The mean length of hospital stay (LHS) was 54.56 ± 54.57 days, and 24% of patients had an LHS of more than 50 days. Longer LHS (> 50 days) was associated with patients who did not receive a compatible initial antibiotic, whereas shorter LHS was associated with patients who received Impenem or a combination of vancomycin and meropenem as alternative antibiotics following incompatibility. Reconstruction patients had significantly longer LHS and a higher mean temperature. However, none of the studied variables were found to be predictors of long LHS in the multivariate regression analysis. CONCLUSION Knowledge of the values that predict LHS allows for patient-centered treatment and may be useful in predicting more radical treatments or the need for additional treatment in high-risk patients. Future multicenter prospective studies with larger sample sizes are needed to assess the needed variables and predictors of long LHS.
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Affiliation(s)
- Bandar Alhubaishy
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Omar M Bahassan
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Ali H Alkhzaim
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ziyad A Alnefaie
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Kamal S Algarni
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sultan G Almehmadi
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - Saud N Alqahtani
- Urology Department, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Tazeoglu D, Benli S, Esmer AC, Colak T, Apaydin FD. Effect of Sarcopenia on Mortality and Morbidity in Patients With Fournier's Gangrene. Am Surg 2023; 89:5527-5534. [PMID: 36849105 DOI: 10.1177/00031348231160840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Preoperative sarcopenia is an essential factor that negatively affects postoperative results. The effect of preoperative sarcopenia on postoperative complications and prognosis in patients treated for Fournier's gangrene (FG) is controversial. This retrospective cohort study analyzed the effect of FG to evaluate the effect of preoperative sarcopenia on postoperative complications and prognosis in patients who were operated on. METHOD The data of patients who were operated on with FG diagnosis in our clinic between 2008 and 2020 were reviewed retrospectively. Demographic data (age and gender), anthropometric measurements, preoperative laboratory values, abdominopelvic CT, location of FG, number of debridements, ostomy, microbiological culture result, wound closure method, length of hospital stay, and overall survival were recorded. In addition, the presence of sarcopenia was determined according to psoas muscular index (PMI) and Hounsfield unit average calculation (HUAC). RESULTS Of the patients, 57 (30.8%) were female and 128 (69.2%) were male. According to the PMI, sarcopenia was detected in 67 (36.2%) patients and 70 (37.8%), according to the HUAC. At the end of one postoperative year, the mortality rate was higher in the sarcopenia group than in the non-sarcopenia group (P = .002, P = .01). According to the PMI, patients with sarcopenia have an 8.17 times greater risk of exitus than non-sarcopenic patients. According to the HUAC, patients with sarcopenia have a 4.21 times greater risk of exitus than non-sarcopenic patients. CONCLUSION Based on this large retrospective study, sarcopenia is a strong and independent predictor of postoperative mortality after Fournier's treatment for gangrene.
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Affiliation(s)
- Deniz Tazeoglu
- Department of Surgical Oncology Surgery, Faculty of Medicine, Mersin University, Turkey
| | - Sami Benli
- Department of Surgical Oncology Surgery, Faculty of Medicine, Mersin University, Turkey
| | - Ahmet Cem Esmer
- Department of Surgical Oncology Surgery, Faculty of Medicine, Mersin University, Turkey
| | - Tahsin Colak
- Department of Surgical Oncology Surgery, Faculty of Medicine, Mersin University, Turkey
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Yilmaz Başer H, Zümrütbaş AE, Yilmaz A, Çelen S, Başer A. Importance of emergency department waiting period in Fournier's Gangrene; 10 years of experience. Int J Clin Pract 2021; 75:e14361. [PMID: 33993614 DOI: 10.1111/ijcp.14361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/11/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a disease with high mortality rate. The first diagnosis is performed in the emergency department (ED). In this study, we investigated the importance of the time period for diagnosis in the ED. METHODS The data of patients who were treated for FG between 1 January 2010 and 2020 were retrospectively analysed. Waiting period of the patients in ED was calculated. Risk factor score calculations were calculated to predict FG mortality and prognosis. The effects of the ED waiting period on the duration of admission to the hospital, the number of debridements and mortality status and relationship with FG mortality risk factor scores were investigated. RESULTS In a 10-year period, a total of 66 patients were included in the study. It was found that the median age of the patients was 56 years. ED waiting period median (IQR) was 105 (115) minutes. It was observed that there was a significant positive correlation between the ED waiting period, duration of admission to hospital (rs: 0.537, P < .001) and patients mortality status (rs: 0.482, P < .001). The ED waiting period was higher in patients with FG mortality. It was observed that the ED waiting period holds a diagnostic value in predicting mortality (P < .001). The cut-off limit predicted for this value was determined as 136 minutes. CONCLUSION FG is a urological emergency. ED waiting period affects mortality rate and length of hospital stay. The earlier the diagnosis and treatment is conducted in the ED, the lower the mortality rate and length of stay in the hospital will be.
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Affiliation(s)
- Hülya Yilmaz Başer
- Medical Faculty, Department of Emergency Medicine, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Ali Ersin Zümrütbaş
- Medical Faculty, Department of Urology, Pamukkale University, Denizli, Turkey
| | - Atakan Yilmaz
- Medical Faculty, Department of Emergency Medicine, Pamukkale University, Denizli, Turkey
| | - Sinan Çelen
- Medical Faculty, Department of Urology, Pamukkale University, Denizli, Turkey
| | - Aykut Başer
- Medical Faculty, Department of Urology, Bandirma Onyedi Eylul University, Balikesir, Turkey
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Wöhler A, Schwab R, Güsgen C, Schaaf S, Weitzel C, Jänig C, Willms A. [Diagnosis and Treatment of Severe Fournier's Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature]. Zentralbl Chir 2021; 147:480-491. [PMID: 33556981 DOI: 10.1055/a-1319-1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the evaluation of risk factors and comorbidities, on the bacteriological spectrum, laboratory analyses, mortality and the course according to the algorithmic approach. METHOD The medical records were reviewed of 10 patients with severe Fournier's gangrene from 2010 to 2019 who underwent intensive care therapy for at least 48 hours. Ten patients with Fournier's gangrene and sepsis and intensive therapy lasting at least 48 hours were recorded and analysed descriptively. RESULTS The patient cohort consisted of six men and four women with a median age of 62 years (range 42 - 78 years). The median time between the onset of symptoms and hospitalisation was four days (range 3 - 5 days). The commonest aetiological event was a minor trauma. Predisposing factors included diabetes mellitus (30%) and overweight (80% BMI > 25). 90% of patients exhibited polymicrobial infection. All patients had systemic sepsis with SOFA-Score between 3 and 17 points. The mortality rate was 40%. Significant differences between surviving and deceased patients were shown by PCT, INR and aPTT (p < 0.05). CONCLUSION Severe Fournier's gangrene continues to be a major challenge with a high mortality rate. Only rapid diagnosis, urgent extensive surgical debridement and intensive care therapy can lead to a favourable outcome in these critically ill patients. Vacuum-assisted closure can be successfully used in the management of soft-tissue defects.
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Affiliation(s)
- Aliona Wöhler
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Robert Schwab
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Christoph Güsgen
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Sebastian Schaaf
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Carolin Weitzel
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Christoph Jänig
- Klinik für Anästhesie, Intensivmedizin und Notfallmedizin, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
| | - Arnulf Willms
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland
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Auerbach J, Bornstein K, Ramzy M, Cabrera J, Montrief T, Long B. Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives. Open Access Emerg Med 2020; 12:353-364. [PMID: 33204184 PMCID: PMC7665443 DOI: 10.2147/oaem.s238699] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Fournier gangrene (FG) is a rare and life-threatening urosurgical emergency characterized most often by a polymicrobial infection of the perineal, genital, or perianal region. FG has an increased incidence in male patients, patients with alcoholism, and patients with immunocompromise including human immunodeficiency virus (HIV) and uncontrolled diabetes. FG often begins as a simple abscess or cellulitis with progression to necrotizing soft tissue infection (NSTI). Delays in diagnosis and treatment confer high mortality. Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle. The most significant modifiable risk factor associated with NSTI mortality is delay to surgical intervention. Coordination of both inpatient medical and surgical teams to implement appropriate therapy is vital to successful outcomes. The emergency medicine clinician must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management. The objective of this review is to provide updated and relevant information regarding recognition, diagnosis, and management of FG for the emergency medicine provider.
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Affiliation(s)
- Jonathan Auerbach
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kasha Bornstein
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mark Ramzy
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jorge Cabrera
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tim Montrief
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USA
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García-García A, Galeano-Valle F, Nuevo-González JA, Demelo-Rodríguez P. Gangrena de Fournier e inhibidores de la SGLT2: a propósito de un caso. ENDOCRINOL DIAB NUTR 2020; 67:423-425. [DOI: 10.1016/j.endinu.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/11/2019] [Accepted: 12/27/2019] [Indexed: 11/15/2022]
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Dos-Santos DR, Roman ULT, Westphalen AP, Lovison K, Spencer Neto FAC. Profile of patients with Fournier's gangrene and their clinical evolution. Rev Col Bras Cir 2018; 45:e1430. [PMID: 29451646 DOI: 10.1590/0100-6991e-20181430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the profile of patients with Fournier's gangrene treated in a public tertiary hospital in western Paraná State. METHODS we conducted a cross-sectional, retrospective and descriptive study of patients with Fournier's gangrene treated between January 2012 and November 2016. RESULTS there were 40 patients with Fournier's gangrene treated in the period, 29 (72.5%) men and 11 (27.5%) women. The mean age was 51.7±16.3 years. The mean time of disease progression, from the initial symptom to hospitalization, was 10.5±1.2 days. All patients had clinical signs such as pain, bulging, erythema, among others, and 38 (95%) had associated comorbidities, the most common being type 2 diabetes mellitus and systemic arterial hypertension. The majority (30 patients - 75%) had perianal abscess as the probable etiology. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 1.8±1.1 surgeries per patient. Nine (22.5%) patients died. There was a strong correlation between the presence of sepsis on admission and mortality. CONCLUSION Fournier's gangrene patients in this series had a long disease duration and a high prevalence of comorbidities, with a high mortality rate.
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Affiliation(s)
| | | | | | - Keli Lovison
- University of São Paulo, Ribeirão Preto, SP, Brazil
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Hong KS, Yi HJ, Lee RA, Kim KH, Chung SS. Prognostic factors and treatment outcomes for patients with Fournier's gangrene: a retrospective study. Int Wound J 2017; 14:1352-1358. [PMID: 28944569 DOI: 10.1111/iwj.12812] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022] Open
Abstract
Fournier's gangrene is a gas-forming, necrotising soft tissue infection affecting the perineum. It spreads rapidly along the deep fascial planes and is associated with a high mortality rate. With a growing elderly population with comorbidities, the frequency of severe cases of Fournier's gangrene is expected to increase. We retrospectively reviewed 20 patients diagnosed with Fournier's gangrene at our institution from 2003 to 2014 and analysed data. Thirteen patients had diabetes mellitus, two had been diagnosed with liver cirrhosis, and four were chronic alcoholics. Of 15 patients admitted to an intensive care unit, 11 underwent colostomy, and 4 required skin grafts for wound healing. The wide wounds of two patients were healed using vacuum-assisted closure (VAC® ) dressing without additional surgery. The mortality rate was 25%, and the patients whose Fournier's gangrene severity index (FGSI) score was higher than 9 points or whose blood urea nitrogen (BUN) level was higher than 50 mg/dl had a poor prognosis. In order to treat Fournier's gangrene, aggressive surgical treatment, including wide debridement and stoma creation, should be considered as soon as possible to improve survival rates. Additionally, VAC dressing is helpful in healing the wide debridement wound without additional reconstructive surgery.
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Affiliation(s)
- Kyung Sook Hong
- Department of Surgery and Critical Care Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hee Jung Yi
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ryung-Ah Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kwang Ho Kim
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soon Sup Chung
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
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Tarchouli M, Bounaim A, Essarghini M, Ratbi MB, Belhamidi MS, Bensal A, Zemmouri A, Ali AA, Sair K. Analysis of prognostic factors affecting mortality in Fournier's gangrene: A study of 72 cases. Can Urol Assoc J 2015; 9:E800-4. [PMID: 26600888 DOI: 10.5489/cuaj.3192] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
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 non-survivors 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.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Ahmed Bounaim
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Essarghini
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Moulay Brahim Ratbi
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Mohamed Said Belhamidi
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelhak Bensal
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Adil Zemmouri
- Department of Anesthesiology and Intensive Care, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Abdelmounaim Ait Ali
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Khalid Sair
- Department of Digestive Surgery, Mohammed V Military Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
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Sebastian-Valverde E, Pañella-Vilamú C, Membrilla-Fernández E, Sancho-Insenser JJ, Grande-Posa L. Retroperitoneal necrotizing fasciitis secondary to Fournier’s gangrene. Eur Surg 2015. [DOI: 10.1007/s10353-015-0346-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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García Marín A, Turégano Fuentes F, Cuadrado Ayuso M, Andueza Lillo JA, Cano Ballesteros JC, Pérez López M. Predictive factors for mortality in Fournier' gangrene: a series of 59 cases. Cir Esp 2014; 93:12-7. [PMID: 24862684 DOI: 10.1016/j.ciresp.2014.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/23/2014] [Accepted: 03/30/2014] [Indexed: 11/30/2022]
Abstract
AIMS Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department. METHODS Retrospective analysis study between 1998 and 2012. RESULTS Of the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P=.023), hemoglobin (S 13; D 11; P=.014), hematocrit (S 37; D 31.4; P=.009), white blood cells (S 17,400; D 23,800; P=.023), serum urea (S 58; D 102; P<.001), creatinine (S 1.1; D 1.9; P=.032), potassium (S 3.7; D 4.4; P=.012) and alkaline phosphatase (S 92; D 133; P=.014). Predictive scores: Charlson index (S 1; D 4; P=.013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; P=.001), Fournier's gangrene severity index score (FGSIS) (S 4; D 7; P=.002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P=.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760-0.973), higher than FGSIS (0.746 [0.601-0.981]) and UFGSI (0.760 [0.617-0.904]). CONCLUSIONS FG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described.
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Affiliation(s)
- Andrés García Marín
- Servicio de Cirugía de Urgencias, Hospital Universitario San Juan, Alicante, España; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Elche, España.
| | - Fernando Turégano Fuentes
- Sección Cirugía de Urgencias, Servicio de Cirugía General 2, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Marta Cuadrado Ayuso
- Sección Cirugía de Urgencias, Servicio de Cirugía General 2, Hospital General Universitario Gregorio Marañón, Madrid, España
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Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon 2013; 11:222-32. [PMID: 23578806 DOI: 10.1016/j.surge.2013.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/30/2013] [Accepted: 02/01/2013] [Indexed: 12/20/2022]
Abstract
Fournier's gangrene (FG) is a synergistic polymicrobial gangrenous infection of the perineum, scrotum and penis which is characterised by obliterative endarteritis of the subcutaneous arteries, resulting in gangrene of the subcutaneous tissue and the overlying skin. FG affects all ages and both genders, with a male preponderance. It is a rare but life-threatening disease, and despite therapeutic advances in recent years, the mortality rate is 3%-67%, with an incidence of 1:7500-1:750,000. Anorectal, genitourinary and cutaneous sources of infection are the most common causes of FG, with diabetes mellitus being the most common risk factor. The clinical condition presents evolution from 2 to 7 days and is characterised by uneasiness, local swelling and discomfort, fever, crepitus and sometimes frank septic shock. Current imaging techniques for initial evaluation of the disease include radiography, Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). However, the diagnosis of FG is usually clinical and imaging can be helpful in uncertain diagnosis and when clinical findings are ambiguous. Treatment of FG is based on a multimodal approach which includes intensive fluid resuscitation to stabilise the patient and correction of electrolyte imbalance, if any. This is followed by extensive debridements and resections in order to remove all necrotic and infected tissue, wide spectrum antibiotics and reconstructive surgery, whenever required. However, despite all the advances in treatment today, FG remains a surgical emergency, hence, early recognition with aggressive haemodynamic stabilisation, parenteral broad spectrum antibiotics and urgent surgical debridement are the mainstay of treatment.
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Affiliation(s)
- Devajit Chowlek Shyam
- Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India.
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Rubegni P, Lamberti A, Natalini Y, Fimiani M. Treatment of two cases of Fournier's gangrene and review of the literature. J DERMATOL TREAT 2012; 25:189-92. [PMID: 23164064 DOI: 10.3109/09546634.2012.751480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fournier's gangrene is a rare polymicrobial necrotising soft tissue infection affecting the perineum and scrotum. It is rapidly progressive, destructive and associated with high morbidity and mortality. Management protocol includes prompt diagnosis, early institution of antibiotic therapy and adequate wound debridement, usually requiring multiple operations. Rapid accurate diagnosis is crucial for successful outcome, while early aggressive surgical intervention together with fluid, hemodynamic and nutritional support and broad-spectrum antibiotics are essential to reduce mortality. Dermatologists are often the first specialist consulted. Two cases of Fournier's gangrene are reported in this report. The aim of the report is to underline the importance of an immediate diagnostic approach to save patients, favoured by a close collaboration among dermatologist, surgeon and urologist.
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Affiliation(s)
- Pietro Rubegni
- Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University of Siena , Italy
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15
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Jiménez-Pacheco A, Arrabal-Polo MÁ, Arias-Santiago S, Arrabal-Martín M, Nogueras-Ocaña M, Zuluaga-Gómez A. Fournier gangrene: description of 37 cases and analysis of associated health care costs. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:29-35. [PMID: 22445562 DOI: 10.1016/j.adengl.2011.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 04/09/2011] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fournier gangrene is a urological emergency associated with a high mortality. It is a necrotizing fasciitis caused by polymicrobial infection originating in the anorectal or genitourinary area. The aim of this study was to analyze the epidemiological and clinical characteristics of Fournier gangrene along with the variables that influence disease course and mortality in patients treated in our department. MATERIAL AND METHODS We carried out a retrospective study of 37 patients diagnosed with Fournier gangrene between January 2001 and October 2010. RESULTS All the patients were men, 43.2% had diabetes, and the mean age of the patients was 57.68 years. Statistically significant differences were observed between the age of surviving patients and that of patients who died (55.8 and 69.6 years, respectively). The mean hospital stay was 27.54 days and 32.4% of patients required admission to the intensive care unit. Etiology was unknown in 39.8% of cases. Polymicrobial infection was observed in 59.5% of cases. The mean health care cost associated with a patient diagnosed with Fournier gangrene admitted to intensive care and requiring at least 1 procedure in the operating room was €25,108.67. Mortality was 13.5%. Based on analysis of individual comorbid conditions, only ischemic heart disease displayed a statistically significant association with mortality due to Fournier gangrene; ischemic heart disease was also associated with longer hospital stay. CONCLUSIONS Fournier gangrene is associated with high mortality despite appropriate early treatment. Although the condition is infrequent, the high associated health care costs suggest that primary and secondary prevention measures should be implemented.
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Affiliation(s)
- A Jiménez-Pacheco
- Servicio de Urología, Hospital Universitario San Cecilio, Granada, Spain
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Jiménez-Pacheco A, Arrabal-Polo M, Arias-Santiago S, Arrabal-Martín M, Nogueras-Ocaña M, Zuluaga-Gómez A. Gangrena de Fournier. Análisis descriptivo y coste económico-sanitario de nuestra serie de 37 casos. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:29-35. [DOI: 10.1016/j.ad.2011.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/29/2011] [Accepted: 04/09/2011] [Indexed: 10/18/2022] Open
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17
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Flores Cortés M, López Bernal F, Valera Sánchez Z, Prendes Sillero E, Pareja Ciuró F. [Use of vacuum assisted closure (VAC) system in perineal gangrene: presentation of a case]. Cir Esp 2011; 89:682-3. [PMID: 21496794 DOI: 10.1016/j.ciresp.2010.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 04/16/2010] [Accepted: 04/19/2010] [Indexed: 10/14/2022]
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18
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Millán Scheiding M, Suárez Fernández C. Respuesta de los autores. Cir Esp 2010. [DOI: 10.1016/j.ciresp.2010.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jimeno J, Díaz De Brito V, Parés D. [Antibiotic treatment in Fournier's gangrene]. Cir Esp 2010; 88:347-8; author reply 348-9. [PMID: 20851388 DOI: 10.1016/j.ciresp.2010.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 06/01/2010] [Indexed: 01/22/2023]
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