Background:
Fournier’s gangrene is a necrotizing fasciitis
involving the perineal and genital regions. Even today, this
often polymicrobial infection still carries a high mortality rate
and continues to be a major challenge to the medical community.
The purpose of this study was to report our experience
with this condition and to compare it with those
reported in published studies. We also introduce our approach
to treatment.
Methods:
We analyzed data from 33 patients with Fournier’s
gangrene who were managed in our hospital from 1996 to
2007, focusing on patient gender, age, etiology, predisposing
conditions, comorbidities, bacteriology, sepsis, blood
results, mortality, and spread of gangrene.
Results:
18 (54.5%) of the 33 patients had been referred to
our department by smaller district hospitals. The patient
cohort consisted of 23 men and ten women with a median
age of 59 years (range 40–79 years). The median time between
the onset of symptoms and progression to gangrene
was 6 days (range 2–28 days). An underlying cause was
identified in 27 patients (81.8%). The commonest etiological
events were perianal and perirectal abscesses (n = 13;
39.4%). Predisposing factors included diabetes mellitus in
12 cases (36.4%), chronic alcoholism in ten cases (30.3%),
immunosuppression in six cases (18.2%), and prolonged
immobilization in five cases (15.2%). 17 patients (51.5%)
had a body mass index (BMI) of 25 or higher, and 13 patients
(39.4%) had a BMI of 30 or higher. Positive cultures
were obtained in 30 cases (90.9%). In 26 cases (78.8%),
multiple microorganisms were recovered, including nine
cases (27.3%) with both aerobes and anaerobes. Sepsis was
present in 26 patients (78.8%). The mortality rate was
18.2%.
Conclusion:
Fournier’s gangrene remains a major challenge
with a high mortality. Our results suggest that women are
more commonly affected than has generally been assumed.
Contrary to published reports, we found that anorectal
sources appear to account for more cases of Fournier’s
gangrene than urological sources.