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You Q, Guan J, Wu B, Du J, Miao Y, Bai X, Ma Y, Zhen S, He Z. Fournier's Gangrene: clinical case review and analysis of risk factors for mortality. BMC Surg 2024; 24:251. [PMID: 39251993 PMCID: PMC11382531 DOI: 10.1186/s12893-024-02547-4] [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: 05/21/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Fournier's Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier's Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives. METHODS This study included 46 hospitalized patients diagnosed with Fournier's Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher's exact test. Differences between numerical variables were compared using Student's t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier's Gangrene. RESULTS Among the 46 Fournier's Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age (P<0.05), extension to the abdominal wall (P<0.01), hematocrit (P<0.01), albumin (P<0.01), SFGSI (P<0.01), and SFGSI>2 (P<0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier's Gangrene patients. CONCLUSION This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier's Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates.
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Affiliation(s)
- Qingyun You
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Jing Guan
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Bensheng Wu
- Department of Anorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, Jiangsu Province, PR China
| | - Jun Du
- Department of Anorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, Jiangsu Province, PR China
| | - Yangyang Miao
- Clinical Laboratory, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, PR China
| | - Xinxin Bai
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Yuhua Ma
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Shuguang Zhen
- Department of Anorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, Jiangsu Province, PR China.
| | - Zongqi He
- Department of Anorectal Surgery, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu Province, PR China.
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El Hajjar C, Al Hassan J, Siblini M, Madi N, Abou Hammin S, Nakib H, Yared G, Ghazal K. Comprehensive management and outcomes in female patients with Fournier's gangrene: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241271829. [PMID: 39157030 PMCID: PMC11329950 DOI: 10.1177/2050313x241271829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/02/2024] [Indexed: 08/20/2024] Open
Abstract
Fournier's gangrene is a severe, life-threatening form of necrotizing fasciitis that predominantly affects the perineal, genital, and perianal areas. It is characterized by a rapid onset and progression, often developing from urogenital infections, diabetes, compromised immune function, or trauma. This report describes the case of a 64-year-old woman who presented with perianal pain and purulent discharge persisting for a week. Upon examination, a substantial necrotic wound was identified in her perineal region, necessitating urgent surgical debridement followed by aggressive postoperative management, including antibiotic therapy and meticulous blood sugar control. Despite initial signs of improvement, the patient's condition deteriorated due to complications from diabetes, acidosis, and pneumonia, ultimately leading to a fatal outcome. This case highlights the critical need for prompt recognition and comprehensive management of Fournier's gangrene, particularly in female patients exhibiting similar symptoms.
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Affiliation(s)
- Charlotte El Hajjar
- Obstetrics and Gynecology Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
| | - Jihad Al Hassan
- Obstetrics and Gynecology Department, Faculty of Science, Lebanese University, Beirut, Lebanon
| | - Mohamad Siblini
- Surgery Department, Rafik Hariri Hospital University Medical Center, Beirut, Lebanon
| | - Nour Madi
- Obstetrics and Gynecology Department, Faculty of Science, Lebanese University, Beirut, Lebanon
| | - Saad Abou Hammin
- Department and Hemodialysis Center in Beirut, General Hospital, Beirut, Lebanon
| | - Hamza Nakib
- The Lebanese American University, Beirut, Lebanon
| | - Georges Yared
- Obstetrics and Gynecology Department, Lebanese American University, Beirut, Lebanon
| | - Kariman Ghazal
- Obstetrics and Gynecology Department, Faculty of Science, Lebanese University, Beirut, Lebanon
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Liang A, Idowu MB, Eskind SJ, Patel SS. Necrotizing Fasciitis Post-Cesarean Section Leading to Transabdominal Hysterectomy. AJP Rep 2024; 14:e235-e238. [PMID: 39351244 PMCID: PMC11442013 DOI: 10.1055/a-2414-7696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/04/2024] [Indexed: 10/04/2024] Open
Abstract
Necrotizing fasciitis (NF) is a rare but life-threatening disease characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissues. Limited literature has described NF as involving an adjacent solid organ beyond fascial planes that has required its removal. We present a case of a 25-year-old white female who underwent a cesarean section and subsequently developed NF involving her uterus and abdominal wall that necessitated a total abdominal hysterectomy, serial surgical debridement of necrotic tissue, and wound vacuum assisted closure (VAC) placement. Her pathology report described her uterus infiltrated by polybacteria, confirming a diagnosis of NF. Despite NF's progressive nature and potential lethality, NF can be challenging to diagnose clinically due to a lack of pathognomonic signs and symptoms. However, early detection of NF with the aid of Laboratory Risk Indicator for Necrotizing Fasciitis score calculation using laboratory values such as white blood cell count, hemoglobin, sodium, glucose, serum creatinine, and C-reactive protein is critical for optimal patient outcomes. A multidisciplinary team approach is vital in treating these patients to debride necrotizing tissue and control the potential sequelae from the infection, particularly for postpartum patients.
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Affiliation(s)
- Alvina Liang
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mary Boluwatife Idowu
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven Joseph Eskind
- Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Soha S Patel
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
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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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Shet P, Mustafa AD, Varshney K, Rao L, Sawdagar S, McLennan F, Ansari S, Shet D, Sivathamboo N, Campbell S. Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review. Surg Infect (Larchmt) 2024; 25:261-271. [PMID: 38625013 DOI: 10.1089/sur.2023.372] [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: 04/17/2024] Open
Abstract
Background: Fournier gangrene (FG) is a form of necrotizing fasciitis involving the perineal, peri-anal, and genital structures, and has exceptionally high mortality rates. To help in early detection of high-risk patients, we aimed to systematically review factors associated with mortality from FG. Patients and Methods: Searches were conducted in PubMed, Embase and Scopus. In our review, a minimum of five patients were required and this was to exclude studies with exceedingly small sample sizes, such as case reports and small case series, with minimal relevance in comparison to larger scale studies. Patient characteristics, causative microbes, anatomic areas of infection, presence of comorbidities, severity scores, causes of FG, and complications were extracted and compared to identify factors related to mortality. Results: A total of 57 studies were included in the review. Across 3,646 study participants, the mortality rate of FG was 20.41%. The mean age of non-survivors was 61.27 years. There were more total male deaths, however, the mortality rate was higher in females. Diabetes mellitus was the most common comorbidity in those who died, but the highest mortality rate was seen in HIV patients (54.17%). Mortality rates did not differ widely among antibiotic agents. Regarding causative organisms, fungal infections had the highest rates of mortality (68.18%) and the most common microbe leading to death was Escherichia coli. Conclusions: Female gender, comorbidities, anatomic distribution, development of sepsis, and fungal infection all increased risk for mortality. Early identification of risk factors, and provision of appropriate treatment are crucial in reducing mortality rates of high-risk patients with FG.
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Affiliation(s)
- Pavan Shet
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | | | - Karan Varshney
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Lavina Rao
- School of Medicine, Monash University, Clayton, Victoria, Australia
| | - Sameen Sawdagar
- Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Florence McLennan
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Siraaj Ansari
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Darshan Shet
- Central Pharmacy Logistics, Coburg North, Victoria, Australia
| | | | - Sian Campbell
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
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6
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Bowen D, Hughes T, Juliebø-Jones P, Somani B. Fournier's gangrene: a review of predictive scoring systems and practical guide for patient management. Ther Adv Infect Dis 2024; 11:20499361241238521. [PMID: 38510990 PMCID: PMC10952983 DOI: 10.1177/20499361241238521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
This article aims to provide a practical guide for patient management and an overview of the predictive scorings for Fournier's gangrene (FG) that are available to aid clinicians. A literature was performed reviewing currently used scoring systems for FG and presenting a practical guide for its management based on the available evidence. There are four specific scoring systems available for the assessment of FG although few other non-specific and generic tools also exist. These specific tools include Laboratory Risk Indicator for Necrotizing Fasciitis, Fournier's Gangrene Severity Index, Uludag Fournier's Gangrene Severity Index, and Simplified Fournier's Gangrene Severity Index and help calculate expected mortality. Our proposed algorithm covers primary assessment, resuscitative interventions, initial investigations, urgent care, post-operative care, and long-term follow-up. The management of the FG patient can be divided into initial resuscitation, surgical debridement, ongoing ward management with antibiotic therapy, wound reconstruction, and long-term follow-up. Each facet of care is vital and requires multidisciplinary team expertise for optimal outcomes. Whilst mortality continues to improve, it remains significant, reflecting the severe and life-threatening nature of FG. More research is certainly needed into how this care is individualised, and to ensure that long-term outcomes in FG include quality of life measures after discharge.
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Affiliation(s)
- Daniel Bowen
- Department of Urology, Mid and South Essex NHS Foundation Trust, Broomfield, UK
| | - Thomas Hughes
- Department of Urology, South Warwickshire University NHS Foundation Trust, Warwick, UK
| | | | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
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Williams B, Gupta A, Koller SD, Starr TJ, Star MJH, Shaw DD, Hakim AH, Leinicke J, Visenio M, Perrone KH, Torgerson ZH, Person AD, Ternent CA, Chen KA, Kapadia MR, Keller DS, Elnagar J, Okonkwo A, Gagliano RA, Clark CE, Arcomano N, Abcarian AM, Beaty JS. Emergency Colon and Rectal Surgery, What Every Surgeon Needs to Know. Curr Probl Surg 2024; 61:101427. [PMID: 38161059 DOI: 10.1016/j.cpsurg.2023.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Brian Williams
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Abhinav Gupta
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Sarah D Koller
- Division of Colon and Rectal Surgery, University Southern California, Los Angelos, CA
| | - Tanya Jt Starr
- Health Corporation of America, Midwest Division, Kansas City, KS
| | | | - Darcy D Shaw
- Health Corporation of America, Midwest Division, Kansas City, KS
| | - Ali H Hakim
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer Leinicke
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Michael Visenio
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Kenneth H Perrone
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | | | - Austin D Person
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Charles A Ternent
- Department of Colon and Rectal Surgery, Creighton University, Omaha, NE
| | - Kevin A Chen
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Muneera R Kapadia
- Division of Gastrointestinal Surgery, University of North Carolina, Chapel Hill, NC
| | - Deborah S Keller
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA; Marks Colorectal Surgical Associates, Wynnewood, PA
| | - Jaafar Elnagar
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA
| | | | | | | | - Nicolas Arcomano
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Ariane M Abcarian
- Department of Surgery, University of Illinois College of Medicine at Chicago, Chicago, IL; Cook County Health, Chicago, IL
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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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Puia D, Gheorghincă Ş, Pricop C. The Antimicrobial Resistance Index and Fournier Gangrene Severity Index of Patients Diagnosed with Fournier's Gangrene in a Tertiary Hospital in North Eastern Romania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040643. [PMID: 37109603 PMCID: PMC10144816 DOI: 10.3390/medicina59040643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023]
Abstract
Background: Although rare, Fournier's gangrene is a major urological emergency. We aimed to learn more about the pathogenesis of Fournier's gangrene and assess the antibiotic resistance patterns in individuals with this disease. Methods: We retrospectively evaluated the patients diagnosed with and treated for Fournier's gangrene in a Neamt county hospital and "CI Parhon" Clinical Hospital in Iasi, Romania between 1 January 2016 and 1 June 2022. Results: We included a total of 40 patients, all males; of these, 12.5% died. In our study, in the patients that died, the adverse prognostic factors were a higher body temperature (38.12 ± 0.68 vs. 38.94 ± 0.85 °C; p = 0.009), an elevated WBC (17.4 ± 5.46 vs. 25.23 ± 7.48; p = 0.003), obesity (14.28% vs. 60%; p = 0.04), and a significantly higher FGSI (4.17 ± 2.80 vs. 9.4 ± 3.2; p = 0.0002) as well as MAR index (0.37 ± 0.29 vs. 0.59 ± 0.24; p = 0.036). These patients were more likely to have liver affections than those in the group who survived, but the difference was not significant. The most frequently identified microorganism in the tissue secretions culture was E. coli (40%), followed by Klebsiella pneumoniae (30%) and Enterococcus (10%). The highest MAR index was encountered in Acinetobacter (1), in a patient that did not survive, followed by Pseudomonas (0.85) and Proteus (0.75). Conclusions: Fournier's gangrene remains a fatal condition, a highly resistant causative microorganism that is not always correlated with a poor prognosis.
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Affiliation(s)
- Dragoş Puia
- "Grigore T. Popa" Department of Urology, University of Medicine and Pharmacy, 700115 Iași, Romania
- "C. I. Parhon" Hospital, Department of Urology, 700503 Iași, Romania
| | | | - Cătălin Pricop
- "Grigore T. Popa" Department of Urology, University of Medicine and Pharmacy, 700115 Iași, Romania
- "C. I. Parhon" Hospital, Department of Urology, 700503 Iași, Romania
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Practice Patterns in Fournier's Gangrene in Europe and Implications for a Prospective Registry Study. Antibiotics (Basel) 2023; 12:antibiotics12020197. [PMID: 36830108 PMCID: PMC9952046 DOI: 10.3390/antibiotics12020197] [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] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a life-threatening, necrotizing infection. Due to the rareness of the disease, it is challenging to plan robust prospective studies. This study aims to describe current practice patterns of FG in Europe and identify implications for planning a prospective FG registry. METHODS Online non-validated 17-items survey among urologists treating FG in in European hospitals. Questionnaires were analyzed with LimeSurvey (LimeSurvey GmbH Hamburg, Germany). RESULTS 229 responses from ten different European countries were submitted, and 117 (51.1%) urologists completed the questionnaire. The departments treat a mean of 4.2 (SD 3.11) patients per year. The urology department mostly takes the lead in treating FG patients (n = 113; 96.6%). The practice in FG is very heterogenic and mostly case-based all over Europe, e.g., vacuum-assisted wound closure (VAC) is mostly used (n = 50; 42.7%) as adjunct wound. The biggest challenges in FG are the short time to diagnosis and treatment, standardization and establishment of guidelines, and disease awareness. Additionally, participants stated that an international registry is an outstanding initiative, and predictive models are needed. CONCLUSIONS There is no standard of care in the diagnosis, treatment, and long-term care of FG all over Europe. Further research could be conducted with a prospective registry.
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11
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Chen GH, Wang Y, Zhang RJ, Leng DL, Li L. Rectal malignant tumor complicated with perianal necrotizing fasciitis: A case report. Shijie Huaren Xiaohua Zazhi 2022; 30:1095-1100. [DOI: 10.11569/wcjd.v30.i24.1095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Perianal necrotizing fasciitis (PNF) has been reported to be caused by multiple factors, but rectal malignant tumors, as an extremely rare predisposing factor, are often easily overlooked by surgeons.
CASE SUMMARY An elderly male patient was admitted due to "right perianal swelling and pain with fever for 3 d" and was diagnosed with PNF, rectal mass, and perianal abscess. The mass was diagnosed as rectal adenocarcinoma after debridement. According to the patient's condition, re-debridement intervention and antibiotic adjustment were given, followed by colostomy and radical resection of the adenocarcinoma. The patient recovered well after 3 mo of follow-up.
CONCLUSION The present case suggests that high attention should be paid to etiological factors of PNF in clinical practice to avoid delayed treatment due to missed diagnosis and misdiagnosis. For patients with rectal malignant tumors and PNF, early diagnosis is very important, and it is still recommended to give priority to the treatment of PNF in the acute phase after diagnosis, followed by comprehensive treatment of rectal malignant tumors, which is of great significance for the prognosis of patients.
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Affiliation(s)
- Guang-Hua Chen
- Department of Anorectal Surgery, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China
| | - Yan Wang
- Jiangxi University of Traditional Chinese Medicine School of Clinical Medicine, Nanchang 330006, Jiangxi Province, China
| | - Ru-Jie Zhang
- Jiangxi University of Traditional Chinese Medicine School of Clinical Medicine, Nanchang 330006, Jiangxi Province, China
| | - Dong-Ling Leng
- Jiangxi University of Traditional Chinese Medicine School of Clinical Medicine, Nanchang 330006, Jiangxi Province, China
| | - Lu Li
- Department of Anorectal Surgery, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, Jiangxi Province, China
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12
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Paladini A, Cochetti G, Tancredi A, Mearini M, Vitale A, Pastore F, Mangione P, Mearini E. Management of Fournier's gangrene during the Covid-19 pandemic era: make a virtue out of necessity. Basic Clin Androl 2022; 32:12. [PMID: 35850577 PMCID: PMC9294754 DOI: 10.1186/s12610-022-00162-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed. We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed. Case presentation A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day. Conclusions FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.
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Affiliation(s)
- Alessio Paladini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Giovanni Cochetti
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy.
| | - Angelica Tancredi
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Matteo Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Andrea Vitale
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Francesca Pastore
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Paolo Mangione
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Ettore Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
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13
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Practical Review of the Current Management of Fournier’s Gangrene. Plast Reconstr Surg Glob Open 2022; 10:e4191. [PMID: 35295879 PMCID: PMC8920302 DOI: 10.1097/gox.0000000000004191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/18/2022] [Indexed: 12/18/2022]
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14
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Panayiotis C, Ioannis K. Fluorescent angiography imaging of intravitreal active bleeding, due to deep venous thrombosis concomitant to Fournier gangrene. Eur J Ophthalmol 2022; 32:NP5-NP8. [DOI: 10.1177/1120672120945106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a breakthrough bleeding in the vitreous cavity due to deep venous thrombosis, in a case of a middle-aged male patient who suffered concomitantly from Fournier’s gangrene. Fluorescent angiography imaging displayed the intravitreal hemorrhage as occurring. Methods: We performed fundus fluorescein angiography and optical coherence tomography at baseline and follow-up examinations. Results: During fluorescein angiography we identified, right eye fluorescent blockage corresponding to a pre-retinal, a subhyaloid, and an intraretinal hemorrhage in the posterior pole. Capillary non-perfusion, and capillary remodeling of the far temporal peripheral vasculature was detected as well, the left eye was unremarkable. A breakthrough bleeding in the vitreous cavity of the upper temporal vein branch was caught as it was happening. We did not observe leaking at the macula; our findings were confirmed with optical coherence tomography throughout the follow-up period. Conclusion: Active retinal bleeding has been reported only twice in the past, in these cases, it was attributed to superficial venous vessel rupture due to vitreous traction or Valsalva-like retinopathy at the site of neovascularization. Active retinal vein bleeding during a fluorescein angiography, secondary to deep venous thrombosis due to Fournier gangrene, has not been previously reported.
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Bensardi FZ, Hajri A, Kabura S, Bouali M, El Bakouri A, El Hattabi K, Fadil A. Fournier's gangrene: Seven years of experience in the emergencies service of visceral surgery at Ibn Rochd University Hospital Center. Ann Med Surg (Lond) 2021; 71:102821. [PMID: 34777789 PMCID: PMC8577414 DOI: 10.1016/j.amsu.2021.102821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction This work aims to describe and discuss the epidemiological, clinical, therapeutic and evolution of Fournier's gangrene. Materials and methods Case series with retrospective data collection of patients treated for Fournier's gangrene between January 2010 and March 2017. The main etiologies, risk factors, postoperative complications outcomes and long term follow up results were analyzed. Results Eight four (84) patients were recruited. The average age of our patients was 49 years (with limits of 20–76), the male gender dominates our series (83.33%) with a sex ratio of 5 M/1W, the most frequently found risk factor was diabetes mellitus (37%). The most common etiology was anal abscesses (32%). The average time to consultation was 8 days (limits ranges from 3 to 30 days). All patients were admitted at a necrosis stage (100%). Anemia was identified in 85% of cases. The low platelets were noticed in 44.03% of cases. Hypoalbuminemia was found in 93% of cases. All patients (100%) benefited resuscitation initially and antibiotic therapy on their admission. They received emergency surgical debridement with a cleansing stoma. The average length of hospital stay was 13 days and complications occurred in 33% of cases. The mortality rate was 7.14%. Conclusion Fournier's gangrene is a medico-surgical emergency with a high morbidity and mortality rate. Early diagnosis as well as antibiotic therapy and the quality of debridement save the patients. Fournier's gangrene is a rare but severe disease. The diagnosis and treatment delay and lesions extension increase mortality. The treatment is multidisciplinary. Early diagnosis and treatment improve prognosis. Tobacco intoxication is suspected to be risk factor.
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Affiliation(s)
- F Z Bensardi
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco.,Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - A Hajri
- Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco.,Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Service of Digestive Cancer Surgery and Liver Transplantation, Morocco
| | - Sylvestre Kabura
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco.,Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
| | - M Bouali
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco
| | - A El Bakouri
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco
| | - K El Hattabi
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco
| | - A Fadil
- Service of Emergency of Visceral Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco.,Hassan II University of Casablanca, Medicine and Pharmacy Faculty, Morocco.,Department of Surgery, Ibn Rochd-Casablanca University Hospital Centre, Morocco
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16
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Lewis GD, Majeed M, Olang CA, Patel A, Gorantla VR, Davis N, Gluschitz S. Fournier's Gangrene Diagnosis and Treatment: A Systematic Review. Cureus 2021; 13:e18948. [PMID: 34815897 PMCID: PMC8605831 DOI: 10.7759/cureus.18948] [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] [Accepted: 10/21/2021] [Indexed: 12/15/2022] Open
Abstract
Fournier's gangrene (FG) is a perineal and abdominal necrotizing infection. It is most commonly found in middle-aged men with comorbidities such as diabetes mellitus. Initial symptoms are often indistinct and can rapidly progress to overwhelming infections with a relatively high mortality rate. It is crucial to make a prompt diagnosis so that the patient receives appropriate treatment. Given the importance of the identification of FG, we explored what were the most common signs and symptoms associated with FG, as well as distinguished the gold standard treatment. This systematic review utilized articles identified exclusively through PubMed using key terms such as Fournier's gangrene, signs, symptoms, and treatment. A total of 37 studies, including a total of 3,224 patients (3,093 males and 131 females), fit our inclusion parameters for relevance that included either the most identifiable presentation of FG or the most effective treatment. From our search, the most common clinical presentation was scrotal and labial pain, fever, abscesses, crepitus, erythema, and cellulitis. Diagnosis is made from clinical findings in conjunction with imaging. The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. The importance of early identification for improved outcomes or survival highlights the need for further studies or measures to enhance the identification of the signs and symptoms of FG.
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Affiliation(s)
- Gregory D Lewis
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Maliha Majeed
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Catherine A Olang
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Arjun Patel
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Vasavi Rakesh Gorantla
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Nelson Davis
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Sarah Gluschitz
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
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17
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Abstract
Fournier gangrene is an emergency condition that is associated with a high mortality rate. It is defined as a rapidly progressing infective necrotizing fasciitis of the perineal, perianal, and genital regions. Early diagnosis, broad-spectrum antibiotic coverage, and adequate surgical debridement are crucial and lead to better prognosis and patient survival. There is increasing utilization of computed tomography (CT) in the initial evaluation of Fournier gangrene. CT can confirm the diagnosis in equivocal cases, determine the source of infection, and evaluate the disease extent. In this pictorial review, we discuss the pathogenesis of Fournier gangrene and display the imaging spectrum with an emphasis on CT findings, including asymmetrical fascial thickening, soft tissue stranding, soft tissue gas, collection, and abscess formation. The infection originating from colorectal pathology, the affected anatomy, and the involvement of the abdominal wall are important predictors of mortality. The familiarity of the varied imaging appearance of Fournier gangrene is necessary to provide an accurate diagnosis, and evaluation of disease extent is crucial for optimal surgical debridement.
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Affiliation(s)
- Sirote Wongwaisayawan
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, Thailand.
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Satheesh Krishna
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mohammad Haroon
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Yashmin Nisha
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Adnan Sheikh
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada
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18
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Zhang N, Yu X, Zhang K, Liu T. A retrospective case series of Fournier's gangrene: necrotizing fasciitis in perineum and perianal region. BMC Surg 2020; 20:259. [PMID: 33126879 PMCID: PMC7602356 DOI: 10.1186/s12893-020-00916-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/18/2020] [Indexed: 11/18/2022] Open
Abstract
Background To describe the clinical characteristics and management for Fournier’s gangrene. Experience summary and literature references are provided for future treatment improvement. Methods We retrospectively reviewed the cases diagnosed with Fournier’s gangrene in our department from June 2016 to June 2019. Clinical data, including manifestation, diagnosis, treatment and outcomes for Fournier’s gangrene were presented. Results There were 12 patients enrolled in this paper, with the average age of 60 years old. It showed a male predominance with male-to-female ratio of 6:1. The average of laboratory risk indicator for necrotizing fasciitis (LRINEC) score was 10.1. Diabetes mellitus was the main predisposing disease. 11 patients received emergency debridement and 1 patient died of sepsis on the 2nd day after admission. The mortality rate was 8.3%. 6 cases developed complications, including sepsis, pneumonia, renal and heart failure. Negative pressure wound therapy (NPWT) was applied in 10 cases, while the rest 1 received normal daily dressing changes because of fecal contamination. Flaps were utilized in 2 patients to cover the defect, including one with advancement flap and one with pudendal-thigh flap, while others received secondary suture, secondary healing, skin graft or combined management. No relapse was observed during the follow-up visits. Conclusions Fournier’s gangrene is a life-threatening infection that requires early diagnosis and surgery intervention. The predisposing disease, clinical manifestation and LRINEC score should be taken into comprehensive consideration, which is helpful for timely diagnosis. Moreover, further successful treatment depends on the aggressive debridement, broad-spectrum antibiotics therapy, wound management and closure choice.
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Affiliation(s)
- Nan Zhang
- General Surgery, Jilin University Second Hospital, No 218 ZiQiang Street, Changchun, 130000, China
| | - Xin Yu
- Department of Pediatrics, Jilin University First Hospital, No 71 Xinmin Street, Changchun, China
| | - Kai Zhang
- General Surgery, Jilin University Second Hospital, No 218 ZiQiang Street, Changchun, 130000, China
| | - Tongjun Liu
- General Surgery, Jilin University Second Hospital, No 218 ZiQiang Street, Changchun, 130000, China.
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19
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Mann AJ, Reinoso DB, Genuit T, Jimenez J. Fournier's Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature. Cureus 2020; 12:e10317. [PMID: 33052278 PMCID: PMC7544611 DOI: 10.7759/cureus.10317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Most case series of Fournier's gangrene (FG) do not list malignancy as a cause; however, isolated cases with underlying malignancy of the soft tissue, genitourinary, and gastrointestinal systems have been described. After a review of recently published literature, 20 case reports and 15 case series or review articles included relevant information and were included in this literature review. Malignancy is overlooked in 10% (2/20) of patients, resulting in a delayed diagnosis and initiation of cancer treatment. All patients with FG should have a thorough cancer history, digital rectal examination, appropriate local and systemic imaging, as well as tissue biopsies, to reduce the likelihood of a missed cancer diagnosis. Delay in management of the local malignancy may lead to persistence or recurrence of the infection and significantly worsens overall outcome and survival.
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Affiliation(s)
- Adam J Mann
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | - Thomas Genuit
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Jesus Jimenez
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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20
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Parkin CJ, Acland G, Ilie V, Clayton S, Merei J, Latif E. Sigmoid diverticulitis leading to Fournier's gangrene. ANZ J Surg 2020; 91:E123-E125. [PMID: 32687238 DOI: 10.1111/ans.16164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Cameron J Parkin
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Region, New South Wales, Australia
| | - George Acland
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Region, New South Wales, Australia
| | - Victor Ilie
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Region, New South Wales, Australia
| | - Siobhan Clayton
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Region, New South Wales, Australia
| | - Jamal Merei
- Department of General Surgery, Gosford Hospital, Central Coast Local Health District, Central Coast Region, New South Wales, Australia
| | - Edward Latif
- Department of Urology, Gosford Hospital, Central Coast Local Health District, Central Coast Region, New South Wales, Australia
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21
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Agwu NP, Muhammad AS, Abdullahi AA, Bashir B, Legbo JN, Mungadi IA. Pattern and outcome of management of Fournier's gangrene in a resource-constraint setting. Urol Ann 2020; 12:248-253. [PMID: 33100750 PMCID: PMC7546073 DOI: 10.4103/ua.ua_62_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Fournier's gangrene (FG) is a necrotizing fasciitis of the external genitalia and perineum but may involve upper thigh and anterior abdominal wall. PATIENTS AND METHODS This is a retrospective study of 47 patients managed for FG at Usmanu Danfodiyo University Teaching Hospital from January 2001 to June 2017. Data were entered into a semi-structured pro forma and analyzed using SPSS version 20.0. RESULTS The mean age of the patients was 42.7 ± 19.4 years, with age range of 7 weeks to 72 years. All the patients were male. The patients had underlying urologic conditions in 27.6%, 15.0% were postoperative, 4.2% had anorectal diseases, 10.6% had medical conditions, and 42.6% were idiopathic. After resuscitation, all the patients had serial debridement, Hypertonic saline bath, broad spectrum antibiotics and wound dressing. The wound healed by secondary intention in 34.0% and 32.3% of the patients had wound closure ± skin graft. The treatment was successful in 68.0% of the patients, 15.0% left against medical advice, and 17.0% died of severe sepsis. CONCLUSION FG mainly affects men with existing urologic conditions in our environment. Aggressive debridement, hypertonic saline sitz bath, broad-spectrum antibiotics, and appropriate wound care are associated with good outcome.
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Affiliation(s)
- Ngwobia Peter Agwu
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Sadiq Muhammad
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Abdulwahab-Ahmed Abdullahi
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bello Bashir
- Department of General Surgery, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Jacob Ndas Legbo
- Department of Plastic and Reconstructive, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ismaila Arzika Mungadi
- Department of Surgery, Urology, Surgery Units, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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22
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Zingaro MD, Boni A, Vermandois JARD, Paladini A, Lepri E, Ursi P, Cirocchi R, Turco M, Gaudio G, Nogara A, Mearini E. Fournier's Gangrene and Intravenous Drug Abuse: an Unusual Case Report and Review of The Literature. Open Med (Wars) 2019; 14:694-710. [PMID: 31934634 PMCID: PMC6947763 DOI: 10.1515/med-2019-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022] Open
Abstract
Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes. In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia. Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties “Paride Stefanini”;, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Division of General Surgery, Department of Surgical and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Nogara
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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Mostaghim A, Dhanani M, Ingalls RR. Fournier's gangrene as an initial manifestation of acute promyelocytic leukemia: A case report and review of the literature. SAGE Open Med Case Rep 2019; 7:2050313X19834425. [PMID: 30854206 PMCID: PMC6399751 DOI: 10.1177/2050313x19834425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/06/2019] [Indexed: 01/23/2023] Open
Abstract
Fournier’s gangrene is classically associated with diabetes mellitus and alcohol use disorder. While it is associated with chemotherapy, there are few case reports of Fournier’s gangrene as the initial presentation of acute myelogenous leukemia. A 38-year-old male presented with progressive scrotal swelling and hematochezia. Blood cell count showed depression of all cell lines without myeloblasts. He received broad-spectrum antibiotics and underwent surgical debridement once. Urgent bone marrow biopsy confirmed acute promyelocytic leukemia. The patient was started on chemotherapy. He was discharged without relapse of the infection. This is the fourth case of acute myelogenous leukemia presenting as Fournier’s gangrene in the literature and the only case to have survived. This brings forth a possible diagnostic consideration in patients without obvious predisposing risk factors for Fournier’s gangrene, particularly in those with pancytopenia. Coordination with surgical services as well as hematology/oncology specialists is imperative to survival of these dual diagnosis patients.
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Affiliation(s)
- Anahita Mostaghim
- Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Muhammad Dhanani
- Section of Infectious Diseases, Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Robin R Ingalls
- Section of Infectious Diseases, Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
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Abstract
Fournier gangrene is a rapidly progressive necrotizing fasciitis of the perianal and genitourinary area. Although typically affects men, we present here a rare disease founding in a pregnant woman. An obese 36-year-old female patient in her third trimester of pregnancy presented with a history of perianal pain and swelling. She was subsequently diagnosed with Fournier gangrene and underwent emergency cesarean section with a surgical debridement. The key to successful outcomes in such a complicated presentation of Fournier gangrene includes a high index of suspicion, fluid resuscitation, rapid administration of broad-spectrum antibiotics, and an early interdisciplinary approach by multiple teams. This helps share decisions and balance the risk-benefit of the emergency caesarian section without delaying the surgical debridement.
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Affiliation(s)
- Saqer Althunayyan
- Department of Accident and Trauma, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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