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Komeda Y, Nagamatsu S, Kaya D, Sueki A, Yamamoto C, Ohta K, Matsuo Y, Nishio Y, Kikukawa S, Matsuura K, Matsuo H, Uejima M, Moriya K. Fournier's Gangrene in the Course of Treatment of Advanced Hepatocellular Carcinoma with Molecular-targeted Therapy. Intern Med 2025; 64:673-678. [PMID: 39048365 PMCID: PMC11949679 DOI: 10.2169/internalmedicine.3907-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024] Open
Abstract
Lenvatinib is a molecular-targeted agent with proven efficacy against hepatocellular carcinoma (HCC). We herein report a case of lenvatinib-associated Fournier gangrene. A 66-year-old man with advanced HCC presented with a high fever 4 weeks after switching to lenvatinib. He had severe erythema in the inguinal region, and abdominal computed tomography revealed extensive emphysema and scrotal abscesses. He was diagnosed with Fournier's gangrene, and his symptoms were successfully treated with local debridement and antimicrobial therapy. Although reports of lenvatinib-associated Fournier's gangrene are rare, they should be kept in mind, as the condition could progress rapidly and have poor outcomes.
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Affiliation(s)
- Yusuke Komeda
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Shinsaku Nagamatsu
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Daisuke Kaya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Ayana Sueki
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Chisa Yamamoto
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Kohei Ohta
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Yuya Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Yuya Nishio
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Shoma Kikukawa
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Kyohei Matsuura
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Hideki Matsuo
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
| | - Masakazu Uejima
- Department of Endocrinology and Metabolism, Nara Prefecture General Medical Center, Japan
| | - Kei Moriya
- Department of Gastroenterology, Nara Prefecture General Medical Center, Japan
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Kamei J, Endo K, Kishino H, Yanase A, Watanabe R, Yokoyama H, Yamazaki M, Sugihara T, Takaoka EI, Ando S, Kume H, Fujimura T. Reliability of superficial swab culture results compared with deep wound culture results in Fournier's gangrene: A retrospective study. J Infect Chemother 2025; 31:102495. [PMID: 39151549 DOI: 10.1016/j.jiac.2024.08.010] [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] [Revised: 07/19/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES To compare isolates from deep wound and superficial swab cultures to evaluate the detectability of pathogens by each culture in Fournier's gangrene; and evaluate the association between microorganisms isolated from deep wounds and those isolated from blood or urine. METHODS Patients with Fournier's gangrene who underwent debridement between October 2006 and January 2023 were retrospectively reviewed. In addition to comparing the isolates from deep wound cultures at initial debridement with those from superficial swab, blood, and urine cultures, the relationship between the traits of the organisms from deep wounds and patient disease severity and prognosis was examined. RESULTS Among 25 patients, deep wound and superficial swab cultures were obtained from 25 to 18 patients, respectively. The frequency of anaerobic isolates was significantly lower in the superficial cultures than in the deep wound cultures (31/76 versus 13/56, p = 0.034). Bacteria not isolated from deep wounds were isolated from superficial cultures in 55.6 % of the patients; the concordance rate between deep and superficial cultures was 27.8 % (5/18). The positive rates of blood and urine cultures were 20.8 % and 35.7 %, respectively; all isolates from the urine and blood cultures reflected the results of the deep wound culture. No significant association was observed between the severity or mortality and the type of causative bacteria. CONCLUSIONS Superficial swab cultures cannot be substituted for deep wound cultures in Fournier's gangrene. Although the positivity rates for blood and urine cultures were not high, they were helpful in determining antibiotic de-escalation.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan; Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | - Kaori Endo
- Department of Urology, Jichi Medical University, Tochigi, Japan; Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan
| | - Hiroto Kishino
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Atsushi Yanase
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Risako Watanabe
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | | | - Toru Sugihara
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | | | - Satoshi Ando
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Haruki Kume
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Yönder H, Çelik M, Berhuni MS, Genç AC, Elkan H, Tatlı F, Özgönül A, Çiftçi F, Erkmen F, Karabay O, Uzunköy A. Fournier's Gangrene Mortality Index (FGMI): A New Scoring System for Predicting Fournier's Gangrene Mortality. Diagnostics (Basel) 2024; 14:2732. [PMID: 39682646 DOI: 10.3390/diagnostics14232732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 11/29/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
OBJECTIVES Fournier's gangrene is an aggressive, rapidly progressing, and life-threatening necrotizing fasciitis of the perineal and genital regions. Various scoring systems have been developed for predicting survival and prognosis in Fournier's gangrene. This retrospective study aimed to evaluate the effectiveness of the newly developed Fournier's gangrene mortality index (FGMI) in predicting mortality associated with Fournier's gangrene. METHODS The study included patients over the age of 18 years who were followed-up with a diagnosis of Fournier's gangrene in the general surgery clinics of three different hospitals in Şanlıurfa province between 2014 and 2024. The patients included in this study were divided into two groups: deceased (n = 20) and surviving (n = 149). In FGMI, the parameters used were age, creatinine level, albumin level, lymphocyte percentage, and neutrophil-to-lymphocyte ratio. Based on the total score and risk assessment, <5 points were categorized as low-to-moderate mortality risk and ≥5 points as high mortality risk. RESULTS A total of 169 patients with a diagnosis of Fournier's gangrene were included in the study; 87 were men (51.48%). The median age of all patients was 53 (40-63) years; 20 patients (11.8%) died. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score did not show a statistically significant difference between the deceased and surviving groups (p = 0.5). Compared to the survivors, the deceased had higher neutrophil counts, neutrophil percentages, neutrophil-to-lymphocyte ratios, platelet-to-lymphocyte ratios, and C-reactive protein-to-albumin ratios, whereas lymphocyte counts, lymphocyte percentages, eosinophil counts, eosinophil percentages, monocyte counts, and monocyte percentages were lower, and these differences were statistically significant. According to receiver operating characteristic (ROC) analysis, the ROC-area under the curve for predicting mortality based on an FGMI score of ≥5 was 0.88 (95% CI: 0.80-0.95) with a sensitivity of 90% and a specificity of 70% (p < 0.001). Univariate risk analysis was performed, and the odds ratio revealed that mortality risk in patients followed-up for Fournier's gangrene with a FGMI score of ≥5 was 20 times higher (4.48-90.91) (p < 0.001). CONCLUSIONS The results reveal that the FGMI score is a scoring system that can predict mortality at the initial clinical presentation of patients with Fournier's gangrene. Another important finding of the present study is that the LRINEC score was not sufficiently effective in predicting mortality.
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Affiliation(s)
- Hüseyin Yönder
- Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
| | - Mehmet Çelik
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
| | - Mehmet Sait Berhuni
- Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
| | - Ahmed Cihad Genç
- Department of Internal Medicine, Sakarya Training and Research Hospital, Sakarya 54290, Turkey
| | - Hasan Elkan
- Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
| | - Faik Tatlı
- Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
| | - Abdullah Özgönül
- Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
| | - Felat Çiftçi
- Clinic of General Surgery, Şanlıurfa Training and Research Hospital, Şanlıurfa 63250, Turkey
| | - Fırat Erkmen
- Clinic of General Surgery, Şanlıurfa Balıklıgöl State Hospital, Şanlıurfa 63050, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sakarya University, Sakarya 54290, Turkey
| | - Ali Uzunköy
- Department of General Surgery, Faculty of Medicine, Harran University, Şanlıurfa 63300, Turkey
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Kundan M, Ambedkar SN, Kumar R, Nyekha V. Outcome of Fournier's gangrene in relation to Fournier Gangrene Severity Index (FGSI) score. J Family Med Prim Care 2024; 13:2941-2945. [PMID: 39228567 PMCID: PMC11368264 DOI: 10.4103/jfmpc.jfmpc_1830_23] [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: 11/15/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Fournier's gangrene is a rapidly progressive necrotizing fasciitis, involving perineum mainly. The purpose of the study is to evaluate etiology, treatment, and outcome of Fournier's gangrene so that such type patient's management can be done by primary care physicians with best outcomes. Method This was a retrospective study including 156 patients, treated for Fournier's gangrene, between Jan 2012 and Dec 2018. The outcome and prognosis of Fournier's gangrene were reviewed. Result The mean age and mode among survival patients were 47.94 ± 14.9 and 60 years, and the mean age and mode in nonsurvival patients was 47.64 ± 15.9 and 65 years. The most common predisposing factor was diabetes mellitus (n = 49, 31.4%) having mortality rate was 9% (n = 14). Most common causative bacteria were E. coli. In the study, the survival rate was 100% in patients having Fournier Gangrene Severity Index (FGSI)≤3. As FGSI increased from 3, the mortality rate increased. Conclusion Fournier gangrene is a surgical emergency. Early diagnosis, serial surgical debridement, and broad-spectrum antibiotics decrease the mortality and morbidity of patients. The sensitivity and specificity of FGSI determine the prognosis of Fournier's gangrene. FGSI is a simple method to know the severity and prognosis.
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Affiliation(s)
- Meghraj Kundan
- Professor, Department of Surgery, VMMC and Safdarjung Hospital, Delhi, India
| | - Shivlok N Ambedkar
- Assosiate Professor, Department of Medicine, VMMC and Safdarjung Hospital, Delhi, India
| | - Rambharosh Kumar
- Assistant Professor, Department of Surgery, GTB and UCMS Hospital, Delhi, India
| | - Vekhotso Nyekha
- PG Resident, Department of Surgery, VMMC and Safdarjung Hospital, Delhi, India
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Susini P, Marcaccini G, Efica J, Giuffrè MT, Mazzotta R, Caneschi C, Cuomo R, Nisi G, Grimaldi L. Fournier's Gangrene Surgical Reconstruction: A Systematic Review. J Clin Med 2024; 13:4085. [PMID: 39064124 PMCID: PMC11278345 DOI: 10.3390/jcm13144085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/28/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Fournier's gangrene (FG) is a rare form of necrotizing fasciitis of the perineal, genital, or perianal region. It is characterized by an aggressive course and high mortality rate, over 20%. FG demands immediate treatment including resuscitation maneuvers, intravenous antibiotic therapy and early surgical debridement. Background/Objectives: The gold-standard treatment for FG is surgical reconstruction. However, up to date, no precise guidelines exist. Thus, we decided to systematically review the literature, focusing on FG contemporary approaches to reconstructive surgery, aiming to analyze the various reconstructive strategies and their specific indications. Methods: A systematic review was carried out according to the PRISMA statement by searching various databases from April 2014 to April 2024, using the terms ''Fournier Gangrene OR Fournier Gangrene Reconstruction OR Fournier Gangrene Treatment OR Fournier Gangrene Plastic Surgery OR Necrotizing Fasciitis OR Necrotizing Fasciitis AND Reconstruction". The eligibility criteria included original studies aimed at discussing FG reconstruction with at least three clinical cases. Results: The final synthesis included 38 articles, and 576 reconstructions were described. Of these, 77.6% were minimally invasive strategies (direct closure, secondary healing, grafts, and local random flaps), while more invasive reconstructions (loco-regional flaps based on known vascular anatomy) were adopted in 22.4%. No free flaps were reported. Conclusions: FG requires immediate medical interventions including broad-spectrum antibiotic therapy, surgical debridement, adjuvant therapies, and reconstructive surgeries. Taking into account the anatomical characteristics of the inguinal-crural region, skin grafts and local random flaps could offer versatile and effective reconstructions for most FG cases, while the more invasive strategies should be reserved for very few cases. Future research is warranted to define an FG dedicated reconstruction protocol.
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Affiliation(s)
- Pietro Susini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Gianluca Marcaccini
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Jessica Efica
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Maria Teresa Giuffrè
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Ruggero Mazzotta
- Division of General Cardiology, Careggi University Hospital, 50134 Florence, Italy;
| | - Corso Caneschi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, 50134 Florence, Italy;
| | - Roberto Cuomo
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Giuseppe Nisi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
| | - Luca Grimaldi
- Plastic Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.M.); (J.E.); (M.T.G.); (R.C.); (G.N.); (L.G.)
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Ji H, Shen W, Zhou X, Zhang L, Zhao X, Tang Q, Guo C. Clostridium ramosum alone caused Fournier's gangrene in an older Chinese patient with abnormal interleukin levels: A rare case report. Heliyon 2024; 10:e33244. [PMID: 39021985 PMCID: PMC11253045 DOI: 10.1016/j.heliyon.2024.e33244] [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: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Clostridium ramosum is an uncommon Clostridium but is one of the essential anaerobic bacteria that makes up the intestinal microbiota. A highly variable body temperature, the white blood cell count, or an elusory prognosis can reflect Clostridium ramosum infection, especially in patients with Fournier's gangrene. Fournier's gangrene is a rare soft-tissue infection with necrosis that occurs mainly in the perianal and genital regions, males being more susceptible. Here, we report a 70-year-old Chinese man with Fournier's gangrene and high levels interleukins who suffered from Clostridium ramosum infection, identified and verified by matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA sequencing. Fournier's gangrene severity index (FGSI) of the patient was measured once the patient was admitted to hospital. His FGSI was 6, indicating no abnormal condition. He had abnormally high interleukin (IL)-6, IL-8, and IL-10 levels, associated with severe inflammatory conditions. Despite the patient's resuscitation and standardized treatment with antimicrobial drugs, the symptoms did not improve. The patient's condition deteriorated, and he died on hospitalization day 5. Abnormally elevated IL-6, IL-8, and IL-10 levels were a novel finding in a case of Clostridium ramosum infection, leading to Fournier's gangrene. In the present case, a perianal abscess was the predisposing condition for Fournier's gangrene. Close attention should be paid to the isolation and identification of pathogenic Clostridium ramosum during the bacteriological examination of patients with perianal abscesses. IL-6, IL-8, and IL-10 may be critical biomarkers that supplement the FGSI for diagnosing Clostridium ramosum infection leading to Fournier's gangrene in immunosuppressed persons.
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Affiliation(s)
- Hongjian Ji
- Department of Pharmacy, Jiangsu Vocational College of Medicine, Jiangsu, People's Republic of China
| | - Wei Shen
- Department of Pharmacy, Suqian Hospital, Jiangsu Province Hospital, Jiangsu, People's Republic of China
| | - Xiaohua Zhou
- Department of Internal Medicine, Yancheng Third People's Hospital, Jiangsu, People's Republic of China
| | - Linlin Zhang
- Department of Pharmacy, First People's Hospital of Yancheng, Jiangsu, People's Republic of China
| | - Xin Zhao
- Department of Pharmacy, Nanjing Gaochun People's Hospital, Jiangsu, People's Republic of China
| | - Qinfang Tang
- Department of Laboratory Medicine, Yancheng Third People's Hospital, Jiangsu, People's Republic of China
| | - Cheng Guo
- Department of Pharmacy, Jiangsu Vocational College of Medicine, Jiangsu, People's Republic of China
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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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Yang Y, Liu E, Zhang X, Wang L, Chen L. Continuous veno-venous hemofiltration with oXiris hemofilters for the treatment of Fournier's gangrene: A case report series. Heliyon 2024; 10:e30463. [PMID: 38726154 PMCID: PMC11079094 DOI: 10.1016/j.heliyon.2024.e30463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
Background Fournier's gangrene (FG) is a severe form of necrotizing fasciitis primarily caused by gram-negative bacteria. FG can rapidly progress to septic shock, resulting in high mortality rates. In the past, the management of the inflammatory response caused by gram-negative bacteria has been limited. Continuous Veno-Venous Hemofiltration with oXiris hemofilters (oXiris-CVVH) has shown promise in adsorbing inflammatory factors and endotoxins, making it an attractive approach for treating FG. This study aims to provide insights into the characteristics of patients with FG and septic shock who have been successfully treated using oXiris-CVVH, based on a series of patient cases. Results This study presents the management of 4 cases in the intensive care units of a tertiary hospital in southern China. The use of oXiris-CVVH in patients with septic shock and FG yielded valuable practical insights. Conclusion Based on the experience gained from these 4 cases, the utilization of oXiris-CVVH demonstrated potential in reducing the Sequential Organ Failure Assessment (SOFA) score, improving prognosis, and effectively lowering the levels of lactic acid and procalcitonin (PCT) in the blood. Additionally, it facilitated a reduction in the dosage of noradrenaline. Therefore, oXiris-CVVH should be considered as an adjunctive therapy in the treatment of patients with FG and septic shock.
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Affiliation(s)
- Yang Yang
- Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Enhe Liu
- Department of Critical Care Medicine, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, Guangdong, 511330, China
| | - Xijian Zhang
- Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Lichun Wang
- Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
| | - Lei Chen
- Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China
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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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Tamir KT, Bekele FS, Molla MG, Aman MK, Boson MA. Post catheterization Fournier's gangrene involving the entire anterior urethra: case report. Int J Surg Case Rep 2024; 116:109448. [PMID: 38428052 PMCID: PMC10944105 DOI: 10.1016/j.ijscr.2024.109448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Fournier's gangrene is necrotizing fasciitis involving the penis, scrotum, or perineal region. This is to report necrosis of the entire anterior urethra by necrotizing infection even though the involvement of the urethra by Fournier's is a very rare presentation. A high index of suspicion is important for early intervention. The main Mode of treatment for Fournier's gangrene is debridement. CASE PRESENTATION This is a case report for a 58-year-old male patient who presented with penile and scrotal swelling after he was catheterized with NG tube for acute urinary retention. The physical finding shows swollen scrotum with ulcerated necrotic glans penis anteriorly. Laboratory result shows leukocytosis and urine analysis is positive for urinary tract infection and ultrasound shows bladder diverticula with normal prostate volume. He underwent debridement up to the level of membranous urethra and suprapubic catheterization was done. He was treated with antibiotics and wound care and finally, the wound closed. Post-operative cystourethrography was done 9 months later and we offered staged urethroplasty but he decided for permanent SPC. DISCUSSION Fournier's gangrene is a fatal rapidly spreading infection that occurs in the perineal area. Involvement of urethra by necrotizing infection following catheterization is very rare presentation and diagnosis is mostly clinical. Once it is diagnosed the management is surgical debridement. CONCLUSION Fournier's gangrene with urethral involvement is a very rare presentation and a high index of suspicion is important for early diagnosis and management. Following the standard procedural steps of catheterization is important to avoid this complication.
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Affiliation(s)
- Kumlachew Tilahun Tamir
- Tikur Anbessa Specialized Hospital, Addis Ababa University, School of Medicine, Department of Surgery, Urology unit, Ethiopia.
| | - Fitsum Solomon Bekele
- Tikur Anbessa Specialized Hospital, Addis Ababa University, School of Medicine, Department of Surgery, Urology unit, Ethiopia.
| | - Mezegebe Gedefe Molla
- Menelik II Comprehensive Specialized Hospital, an affiliate hospital to Addis Ababa university, Ethiopia
| | - Meki Kiyar Aman
- St. Paul's Hospital Millennium Medical College, Department of Surgery, Plastic Surgery Unit, Ethiopia
| | - Mamush Abera Boson
- St. Paul's Hospital Millennium Medical College, Department of Surgery, Plastic Surgery Unit, Ethiopia
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11
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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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12
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Keten T, Ozercan AY, Eroglu U, Basboga S, Tatlici K, Senel C, Guzel O, Tuncel A. Can HALP score, a new prognostic tool, take the place of traditional scoring systems in Fournier's gangrene? Int Urol Nephrol 2023; 55:2389-2395. [PMID: 37410304 DOI: 10.1007/s11255-023-03695-x] [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: 04/30/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Fournier's Gangrene (FG) is a fatal condition, therefore prognosis prediction is a crucial step before treatment planning. We aimed to investigate the predictive value of Hemoglobin, Albumin, Lymphocyte and Platelet (HALP) score which is frequently employed in vascular disorders and malignancies, on disease severity and survival in FG patients and to compare HALP score with well-known scoring systems on this aspect. MATERIALS AND METHODS Eighty-seven men who had surgical debridement for FG between December 2006 and January 2022 were included in this study. Their symptoms, physical examination findings, laboratory tests, medical histories, vital signs, extent and timing of the surgical debridement and antimicrobial therapies were noted. The HALP score, Age-adjusted Charlson Comorbidity Index (ACCI) and Fournier's Gangrene Severity Index (FGSI) were evaluated for their predictive values for survival. RESULTS FG patients were grouped as survivors (Group 1, n = 71) and non-survivors (Group 2, n = 16) and the results were compared. The mean ages of survivors (59 ± 12.55 years) and non-survivors (64.5 ± 14.6 years) were similar (p = 0.114). The median size of necrotized body surface area was 3% in Group 1 and 4.8% in Group 2 (p = 0.013). On admission, hemoglobin, albumin and serum urea levels and white blood cell counts were significantly different in two study groups. Two study groups were similar for HALP scores. However, ACCI and FGSI scores were greater significantly in non-survivors. CONCLUSIONS Our results indicated that HALP score does not predict a survival successfully in FG. However, FGSI and ACCI are successful outcome predictors in FG.
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Affiliation(s)
- Tanju Keten
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey.
| | - Ali Yasin Ozercan
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Unsal Eroglu
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Serdar Basboga
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Koray Tatlici
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Cagdas Senel
- School of Medicine, Department of Urology, Balıkesir University, Balıkesir, Turkey
| | - Ozer Guzel
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Altug Tuncel
- Department of Urology, University of Health Sciences, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
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13
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Wong AWJ, Tan GHM, Koh FHX, Chew MH. Dynamic Reconstruction of Anal Sphincter with Camera Shutter Style Double-Opposing Gracilis Flaps. Arch Plast Surg 2023; 50:496-500. [PMID: 37808328 PMCID: PMC10556314 DOI: 10.1055/s-0043-1772755] [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: 11/23/2022] [Accepted: 06/14/2023] [Indexed: 10/10/2023] Open
Abstract
Fournier's gangrene is a life-threatening infection which requires prompt recognition, early surgical debridement of unhealthy tissue, and initiation of broad-spectrum antibiotics. Relook debridement are usually performed until all the devitalized tissue has been removed. Involvement of the anal sphincter may result in significant morbidity such as permanent incontinence. Dynamic reconstruction of the anal sphincter has always been one of the holy grails in the field of pelvic reconstruction. We demonstrate a new method of camera shutter style double-opposing gracilis muscle flaps that allows dynamic sphincteric function without the need for electrostimulation. The bilateral gracilis muscles are inset in a fashion that allows orthograde contraction of the muscle to narrow and collapse the neoanal opening. With biofeedback training, the patient is able to regain dynamic continence and return to function without a stoma. There was also no need for neurotization or microsurgery techniques to restore sphincteric function to the anus. The patient was able to reverse his stoma 14 months after the initial insult and reconstruction with biofeedback training without the use of electrostimulation.
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Affiliation(s)
- Allen Wei-Jiat Wong
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Grace Hui-Min Tan
- Plastic, Reconstructive and Aesthetic Surgery Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Frederick Hong-Xiang Koh
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Min Hoe Chew
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, Singapore, Singapore
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14
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Ghabisha S, Ahmed F, Al-Wageeh S, Badheeb M, Alyhari Q, Altam A, Alsharif A. Prognostic determinants and treatment outcomes of Fournier's Gangrene treatment in a resource-limited setting: A retrospective study. Arch Ital Urol Androl 2023; 95:11450. [PMID: 37491981 DOI: 10.4081/aiua.2023.11450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/08/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a destructive necrotizing infection with a generally poor prognosis. This study aims to share our experience in handling FG patients in a resource-limited setting and identify prognostic factors for FG mortality. METHODS A retrospective study of thirty-six patients diagnosed with FG and treated at our teaching hospital between Jun 2010 to Oct 2022 was conducted. Laboratory and nonlaboratory data and patients' outcomes were gathered. A univariate analysis was computed for identifying prognostic factors for FG mortality. RESULT The main age was 68.30 ± 5.61years and most (69.4%) were older than 65 years. The overall survival was 63.9% and the mortality rate was 36.1%. Univariate analysis showed that advanced age (p = 0.02), delayed in hospital presentation (p = 0.024), involvement of larger area (p = 0.001), a history of diabetes mellitus (p < 0.006), end-stage renal disease (p = 0.018), heart failure (p = 0.005), cerebrovascular accident (p = 0.003), liver cirrhosis (p = 0.001), presence of multiple comorbidities (p = 0.001), septic conditions at admission (p = 0.048), need for mechanical ventilation (p = 0.001), hypoalbuminemia (p < 0.001), and elevated blood urea nitrogen (p = 0.002) were found to be risk factors for mortality in patients with FG. CONCLUSIONS Fournier's gangrene is a fulminant condition with a high mortality rate, especially in resource-limited settings. In this study, the mortality rate was 36.1%. Advanced age, delayed in hospital presentation, involvement of larger area, a history of diabetes mellitus, end-stage renal disease, heart failure, cerebrovascular accident, liver cirrhosis, presence of multiple comorbidities, septic conditions at admission, need for mechanical ventilation, hypoalbuminemia, and elevated blood urea nitrogen were associated with FG mortality.
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Affiliation(s)
- Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb.
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb.
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb.
| | - Mohamed Badheeb
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport.
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb.
| | - Abdulfattah Altam
- Department of General Surgery, School of Medicine, 21 September University, Sana'a.
| | - Afaf Alsharif
- Department of Gynaecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb.
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15
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Khalid A, Devakumar S, Huespe I, Kashyap R, Chisti I. A Comprehensive Literature Review of Fournier's Gangrene in Females. Cureus 2023; 15:e38953. [PMID: 37197302 PMCID: PMC10184784 DOI: 10.7759/cureus.38953] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/12/2023] [Indexed: 05/19/2023] Open
Abstract
Fournier gangrene (FG) is a rare but rapidly progressing disease with a higher mortality rate in women as compared to men. This study aims to perform a literature review about FG in females and associated mortality and morbidity. We searched databases including MEDLINE (Ovid), the National Library of Medicine (Medical Subject Headings (MeSH)), the Cochrane Database of Systematic Reviews (Wiley), as well as Embase (Ovid), Scopus, and Global Index Medicus (WHO), and reviewed literature from 2002 to 2022 and selected 22 studies that met our study's inclusion criteria, which included 134 female patients with a mean age of 55±6 years. The perineal abscess was a more common nidus (n=41, 35%; 95%CI 23-39%) than vulvar pathology (n=29, 22%; 95%CI 15-30%). The most common initial presentation was cellulitis (n=62, 46%; 95%CI 38-55%), followed by perineal pain (n=54, 40%; 95%CI 32-50%), fever (n=47, 35%; 95%CI 27-43%), and septic shock (n=38, 28%; 95%CI 21-37%). Escherichia coli was the most frequently identified bacteria (n=48, 36%; 95%CI 28-46%). All patients had treatment with a mean of three (SD 2) debridement and those with negative pressure dressings received fewer debridements than those who received a conventional dressing. However, of those who had surgical intervention, 28 (20%; 95%CI 14-29%) patients underwent diversion colostomy. General surgeons performed 78% (n=104) of cases out of which 20% (n=20) were consulted by obstetrician-gynecologists, 14% (n=18) were treated by urologists, and only 8% (n=10) by plastic surgeons. The mean length of stay in the hospital was 24±11 days, and the gross mortality rate was 27 (20%; 95%CI 14-28%). In conclusion, while females have a low incidence rate of FG, they carry a higher mortality rate. Lack of cardinal signs and delayed presentation to the hospital from the onset of symptoms are some possible causes for the increased mortality rate along with the disease process being under-recognized in women. A high index of clinical suspicion is essential to avoid delay in the definitive management coupled with an early surgical consult and establishing a common general care pathway could minimize mortality and morbidity.
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Affiliation(s)
| | - Sahana Devakumar
- Internal Medicine, Jawaharlal Nehru Medical College, Belgaum, IND
| | - Ivan Huespe
- Critical Care, Hospital Italiano de Buenos Aires, Buenos Aires, ARG
| | - Rahul Kashyap
- Research, Harvard Medical School, Boston, USA
- Research, Global Remote Research Program, Saint Paul, USA
- Critical Care Medicine, Mayo Clinic, Rochester, USA
| | - Imran Chisti
- Critical Care Medicine, University of Miami, Coral Gables, USA
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16
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Ismayilzade M, Dadaci M, Kendir MS, Ince B. Gracilis Muscle Interposition to Fill the Perianal Dead Space May Decrease Hospital Length of Stay in Fournier's Gangrene. Ann Plast Surg 2023; 90:356-362. [PMID: 36921330 DOI: 10.1097/sap.0000000000003517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
PURPOSE The treatment of Fournier's gangrene (FG) includes aggressive debridement of the affected necrotic area, broad-spectrum antibiotic therapy, and reconstructive procedures, respectively. One of the main reasons of unfavorable outcomes in FG surgery is that the dead space occurs in the perianal region because of destruction of fascias and soft tissues. In this study, we aimed to evaluate the results of gracilis muscle flap transposition to fill the FG-associated perianal dead spaces. METHODS Patients treated for FG-associated dead spaces in their perianal region between the years 2017 and 2021 were included in the study. The patients who underwent the pedicled gracilis muscle flap surgery were included in group 1, whereas group 2 consisted of the patients with no additional surgical procedure for dead spaces but only the reconstruction of the soft tissue defects. Demographic data (age, sex), comorbid diseases, localization and length of perianal dead space, and management method for the soft tissue defects and complications were noted. The length of hospital stay and discharge day after surgery were also recorded. RESULTS In group 1, the mean duration of hospital stay was 23.5 ± 5.0 (range, 14-48) days, whereas the mean period between the surgery and discharge was 5.1 ± 2.2 (range, 3-12) days. These numbers were 31 ± 8.3 (range, 19-58) days and 12.7 ± 6.1 (range, 7-22) days in group 2, respectively. Statistical comparison of the periods between the surgery and discharge was found to be significantly different ( P = 0.022). The duration of hospital stay was also shorter in the patients with gracilis muscle flap ( P = 0.039). CONCLUSIONS Perianal dead spaces accompanying many of the patients with FG provide appropriate conditions for bacterial colonization. Filling these pouches by the gracilis muscle flap prevented the progression of infection and enabled the patients to return to their normal life earlier.
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Affiliation(s)
- Majid Ismayilzade
- From the Department of Plastic and Reconstructive and Aesthetic Surgery, Istinye University Faculty of Medicine, Istanbul
| | - Mehmet Dadaci
- Department of Plastic and Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Münür Selçuk Kendir
- Department of Plastic and Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bilsev Ince
- Department of Plastic and Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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17
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Molla YD, Assefa MA, Abraha AY. Fournier's gangrene with retroperitoneal extension, a case report. Int J Surg Case Rep 2023; 105:107984. [PMID: 36944287 PMCID: PMC10036932 DOI: 10.1016/j.ijscr.2023.107984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Fournier's gangrene (FG) is a polymicrobial, both aerobic and anaerobic, synergistic necrotizing fasciitis of the perineal, genital, or perianal regions. It is a rapidly progressive and fulminant soft tissue infection and it is potentially fatal. Fournier's gangrene has been shown to be strongly associated with diabetes, chronic alcoholism, human immunodeficiency virus (HIV), lymphoproliferative diseases, chronic steroid abuse, and cytotoxic drugs. CLINICAL PRESENTATION A 25-year-old Ethiopian male patient with no previous medical history presented to the emergency department with a four-day history of perineal pain, swelling, and discharge. Associated with this he had a high-grade fever and one episode of vomiting of ingested matter. On examination, he was febrile, tachycardic, and hypotensive. He had a grossly necrotic scrotum and palpable crepitus extending to the left lower anterior abdominal wall. CLINICAL DISCUSSION On investigations, he had elevated leukocyte count, random blood sugar, low hemoglobin, and elevated creatinine levels. Subsequently, the patient was admitted and was started with broad-spectrum antibiotics and multiple debridements were done along with other supportive measures. Finally, the patient was discharged improved after 17 days of hospital stay. CONCLUSION Fournier's gangrene is a rapidly progressive, fulminant infection. Nevertheless, prompt diagnosis can be difficult and requires a high index of suspicion. Early diagnosis and appropriate management have paramount importance in reducing mortality and morbidity in these patients.
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Affiliation(s)
- Yohannis Derbew Molla
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia.
| | - Mezgebu Alemneh Assefa
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia
| | - Aklilu Yiheyis Abraha
- Department of Surgery, University of Gondar, Collage of Medicine and Health Sciences, Gondar, Ethiopia
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Temoçin F, Atilla A, Kuruoğlu T, Kamalı-Polat A. Fournier's Gangrene: Microbiological Profile and Risk Factors for Mortality: Review of 97 Cases. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2023; 5:13-22. [PMID: 38633899 PMCID: PMC10985828 DOI: 10.36519/idcm.2023.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/06/2022] [Indexed: 04/19/2024]
Abstract
Objective Fournier's gangrene (FG) is a rare necrotizing fasciitis affecting genital and perianal areas. This study aimed to provide data on predicting factors, mortality rates, and factors affecting mortality in comparison of survivors and non-survivors in patients with FG. Materials and Methods This study included a retrospective analysis of patients diagnosed with FG between 2008 and 2018. Results A total of 97 patients with FG were included in this study. Of the patients, 72 (74%) were male. The mean age was 56.03±13.92 years, and the median was 57 (21-90). The mortality rate was 21.6%. The most frequently isolated microorganism from tissue and blood cultures was Escherichia coli (43%-42%). The median Fournier's Gangrene Severity Index (FGSI) and Uludağ FGSI (UFGSI) scores were 4 (0-20) and 5 (1-22), respectively. In the univariate model, mortality risk increases 7.18 times (p=0.001) in patients with two or more comorbidities, 1.31 times as the FGSI score increases (p<0.001), 1.28 times as the UFGSI score increases (p<0.001). When the cut-off value was set as 8 for the FGSI score, the sensitivity was 71.43%, and the specificity was 73.68%. The sensitivity was 73.43%, and the specificity was 75% when the cut-off value was set as 6 for the UFGSI score. In the univariate model, the mortality risk of those with hypotension was 6.07 times higher (p=0.003); as the platelet count increased, mortality risk decreased (odds ratio [OR]=0.99; p=0.02). The mortality risk of those hospitalized in the intensive care unit (ICU) was 16.5 times higher than those followed in the ward (p<0.001). In the multivariate model, this ratio was 6.49. Conclusion We concluded that FGSI and UFGSI scores could be used to predict mortality. Management of FG requires a multidisciplinary approach. Empiric treatment should include carbapenems and be de-escalated once getting the culture results. Authors from different centers should report their experiences to help reveal the ideal treatment and evaluate the consequences.
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Affiliation(s)
- Fatih Temoçin
- Department of Clinical Microbiology and Infectious Diseases,
Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Aynur Atilla
- Department of Clinical Microbiology and Infectious Diseases,
Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Tuba Kuruoğlu
- Department of Clinical Microbiology and Infectious Diseases,
Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ayfer Kamalı-Polat
- Department of General Surgery, Ondokuz Mayıs University School
of Medicine, Samsun, Turkey
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19
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Lin TY, Su CC, Chang YC, Chen IH, Ou CH, Cheng YS. The sufficient multidisciplinary specialists under a government-led health care system associated with the downward mortality trend of Fournier's gangrene in Taiwan. Int J Urol 2023; 30:182-189. [PMID: 36305805 DOI: 10.1111/iju.15081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To explore the trends in Fournier's gangrene (FG) incidence and mortality rate in Taiwan and to investigate the contributing factors to such changes. METHODS Between 2002 and 2016, hospitalized FG patients who underwent subsequent surgical intervention were included in this retrospective study. Incidence, outcomes, age-adjusted Charlson Comorbidity Index (ACCI), hospitalization cost, surgical timing, and the number of multidisciplinary specialists involved in the first-line management of FG in each year were collected. Simple linear regression and Pearson correlation coefficient (r) were used for the subsequent analysis. RESULTS The national cohort enrolled 2183 FG patients from 2002 to 2016 in Taiwan. The age-standardized incidence rate of FG was between 0.4 and 0.8 per 100 000 population, and overall mortality was 7.8% in these 15 years. We illustrated the downward trendline of FG mortality with a 0.62 coefficient of determination. The mortality of FG patients who underwent surgery within 24 h and after 24 h were found to be 8.3 ± 3.9% and 14.6 ± 25.2%, respectively (p = 0.02). The numbers of urologists, anesthesiologists, emergency doctors, and physicians per 100 000 population had a strong negative linear correlation with FG mortality (r = 0.8, p < 0.001). ACCI score had a moderate linear relationship with FG mortality (r = 0.57, p = 0.027). The hospitalization cost showed a weak linear correlation with FG mortality (r = -0.03, p = 0.92). CONCLUSIONS We demonstrated the downward trend of the FG mortality rate in Taiwan from 2002 to 2016. Besides underlying comorbidities and surgical timing, sufficient multidisciplinary specialists are essential for the survival benefit of FG patients in Taiwan experience.
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Affiliation(s)
- Tsung-Yen Lin
- Division of Urology, Department of Surgery, Dou-Liou Branch, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Chien-Chou Su
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Chang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan
| | - I-Hung Chen
- Division of Urology, Department of Surgery, Dou-Liou Branch, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| | - Chien-Hui Ou
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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20
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Carius BM, Long B. Abdominal Extension of Fournier Gangrene From Undiagnosed Crohn's Disease: A Case Report. Mil Med 2023; 188:e426-e429. [PMID: 33742649 DOI: 10.1093/milmed/usab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/17/2021] [Accepted: 03/18/2021] [Indexed: 01/11/2023] Open
Abstract
Cellulitis and abscess are common skin infections in military populations. Although complications of necrotizing soft tissue infections (NSTIs) such as Fournier Gangrene (FG) are rare, they are associated with significant morbidity and mortality. Laboratory and radiological studies may aid in the evaluation of NSTI; however, focus should remain on physical examination and prompt surgical consultation, as these infections can spread rapidly with significant increases in mortality with delayed management. We present the case of a 37-year-old male soldier with reported history of two distant left inguinal hernia repairs, complaining of increasing buttock pain despite outpatient antibiotic therapy for perineal cellulitis from his primary clinician. Despite normal vital signs and low risk from established NSTI calculator scores, examination revealed crepitus and severe tenderness extending from the buttock through the perineum and scrotum characteristic of FG. Preoperative computed tomography found additional spread of subcutaneous air from these areas into the lower abdomen, likely facilitated by the previously repaired left inguinal hernia. Surgical management necessitated debridement, multiple washouts, and ileostomy. Follow-up evaluations revealed previously undiagnosed Crohn's disease with fistula-in-ano as the inciting factor.
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Affiliation(s)
- Brandon M Carius
- 121 Field Hospital, Camp Humphreys, APO, AP 96205, Republic of Korea.,Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
| | - Brit Long
- Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
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Salastekar N, Su A, Rowe JS, Somasundaram A, Wong PK, Hanna TN. Imaging of Soft Tissue Infections. Radiol Clin North Am 2023; 61:151-166. [DOI: 10.1016/j.rcl.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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B S, Khanna A, Taylor D. Pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) flap for perineo-scrotal reconstruction following Fournier's gangrene. ANZ J Surg 2023; 93:276-280. [PMID: 36181427 DOI: 10.1111/ans.18066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/29/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fournier's gangrene is a form of necrotising fasciitis involving perineo-scrotal skin. It is treated with radical debridement, infection control and often leaves a large anatomical defect that is challenging to reconstruct. The anatomical location of the defect leads to faecal contamination, difficulties when mobilizing, and negative psychological impact. Traditional approaches for managing such defects have relied on either healing by secondary intention or skin grafting. There are few reported cases in the literature to cover such defects with a flap. METHODS Pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) flap reconstruction was performed in three patients who had perineo-scrotal defects following debridement for Fournier's gangrene. RESULTS All flaps survived with no significant postoperative complications and good functional and aesthetic outcomes were achieved. The mean age of patient was 52 years and the largest defect measured 22 × 10 cm. CONCLUSION The reconstruction of perineo-scrotal defects is difficult despite a range of reconstructive options. The pedicled SCIP flap offers many advantages over standard techniques. This flap is thin, pliable, and has a consistent anatomy. With continued experience, we feel that this flap could be considered the gold standard of treatment for such defects.
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Affiliation(s)
- Sandeep B
- Department of Plastic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Anmol Khanna
- Department of Plastic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Duncan Taylor
- Department of Plastic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Ongaro L, Claps F, Rizzo M, Di Cosmo G, Traunero F, D’Andrea E, Garaffa G, Cai T, Zucchi A, Trombetta C, Liguori G. Procalcitonin as prognostic factor in patients with Fournier’s gangrene. Urologia 2022; 90:157-163. [PMID: 36527222 DOI: 10.1177/03915603221142665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Fournier’s Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG. Materials and methods: The medical records of 20 male FG patients admitted at the Department of Urology of “Cattinara” Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier’s Gangrene Severity Index (FGSI) was calculated for each patient. Results: Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51–88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score ⩾2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2–12) and median PCT 0.8 ng/ml (IQR 0.04–2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25–4.27, p = 0.002). CCI score ⩾2 (OR 1.51, CI 1.01–2.59, p = 0.04), Streptococcical etiology (OR 3.41, CI 2.49–4.61, p = 0.002) and FGSI score >9 (OR 1.41, CI 1.19–2.21, p = 0.004) were associated with unfavorable outcome. Conclusion: PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending.
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Affiliation(s)
- Luca Ongaro
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
| | - Francesco Claps
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
| | - Michele Rizzo
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
| | - Giacomo Di Cosmo
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale San Raffaele Turro, Milan, Italy
| | - Fabio Traunero
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
| | - Eugenia D’Andrea
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
| | - Giulio Garaffa
- Department of Urology, University College London Hospitals, London, UK
| | - Tommaso Cai
- Department of Urology, Santa Chiara Hospital, Trento, Italy
| | - Alessandro Zucchi
- Department of Translationals Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Carlo Trombetta
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, University of Trieste, Cattinara Hospital – ASUGI, Trieste, Italy
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Acute paraproctitis, Fournier's phlegmon: a clinical case. Radical treatment with the plasty of the wound of the perineum and scrotum. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract111006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: The article presents the stages and results of treating a patient with a life-threatening condition caused by acute paraproctitis complicated by necrotizing fasciitis of the perineum and scrotum (Fournier's gangrene). The patient underwent a radical surgical treatment with the removal of the affected tissues, and, in the delayed period, a plastic surgery of the perineum and scrotum with a pedicled flap. Clinical case description: Patient Sh., 62 years old, was hospitalized at the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia on an emergency basis with the following diagnosis: acute horseshoe-shaped posterior paraproctitis; non-clostridial phlegmon of the perineum and scrotum; sepsis. The patient was operated on urgently: a total necrectomy was performed with a wide excision of the affected tissues, excision of the anterior fistula, and a leak along the left inguinal cord into the abdominal cavity was identified and drained. The patient's condition in a few hours after the operation was characterized by pronounced positive dynamics, the effects of intoxication were stopped. 7 hours after the operation, the patient was transferred from the ICU to the department of coloproctology. A repeated surgical treatment with the revision of wounds was not required. 16 weeks after the first operation, a planned operation was performed with an excision of the fistula of the rectum and plasty of the perineum and scrotum with a rotary flap. The wounds healed by first intention. The patient recovered with all the pelvic functions completely restored. Conclusion: This clinical example can be used as a guide for the step-by-step treatment in this category of patients.
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Yang Y, Wang LC, Yu XY, Zhang XF, Yang ZQ, Zheng YZ, Jiang BY, Chen L. How likely is septic shock to develop in a patient with Fournier's gangrene? A risk prediction model based on a 7-year retrospective study. Gastroenterol Rep (Oxf) 2022; 10:goac038. [PMID: 35966629 PMCID: PMC9368829 DOI: 10.1093/gastro/goac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/23/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Fournier's gangrene (FG) is a rare life-threatening form of necrotizing fasciitis. The risk factors for septic shock in patients with FG are unclear. This study aimed to identify potential risk factors and develop a prediction model for septic shock in patients with FG. Methods This retrospective cohort study included patients who were treated for FG between May 2013 and May 2020 at the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, China). The patients were divided into a septic shock group and a non-septic shock group. An L1-penalized logistic regression model was used to detect the main effect of important factors and a penalized Quadratic Discriminant Analysis method was used to identify possible interaction effects between different factors. The selected main factors and interactions were used to obtain a logistic regression model based on the Bayesian information criterion. Results A total of 113 patients with FG were enrolled and allocated to the septic shock group (n = 24) or non-septic shock group (n = 89). The best model selected identified by backward logistic regression based on Bayesian information criterion selected temperature, platelets, total bilirubin (TBIL) level, and pneumatosis on pelvic computed tomography/magnetic resonance images as the main linear effect and Na+ × TBIL as the interaction effect. The area under the ROC curve of the probability of FG with septic shock by our model was 0.84 (95% confidence interval, 0.78-0.95). The Harrell's concordance index for the nomogram was 0.864 (95% confidence interval, 0.78-0.95). Conclusion We have developed a prediction model for evaluation of the risk of septic shock in patients with FG that could assist clinicians in identifying critically ill patients with FG and prevent them from reaching a crisis state.
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Affiliation(s)
| | | | - Xin-Yang Yu
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xiao-Fei Zhang
- Department of Critical Care Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Zhong-Qing Yang
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yang-Zi Zheng
- Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Bin-Yan Jiang
- Corresponding authors. Lei Chen, Department of Critical Care Medicine, the Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, Guangdong 510655, P. R. China. Tel: +86-13570236595; and Bin-Yan Jiang, Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR, China. Tel: +852-27666349;
| | - Lei Chen
- Corresponding authors. Lei Chen, Department of Critical Care Medicine, the Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Erheng Road, Guangzhou, Guangdong 510655, P. R. China. Tel: +86-13570236595; and Bin-Yan Jiang, Department of Applied Mathematics, The Hong Kong Polytechnic University, Hong Kong SAR, China. Tel: +852-27666349;
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Khan A, Gidda H, Murphy N, Alshanqeeti S, Singh I, Wasay A, Haseeb M. An Unusual Bacterial Etiology of Fournier’s Gangrene in an Immunocompetent Patient. Cureus 2022; 14:e26616. [PMID: 35936142 PMCID: PMC9355918 DOI: 10.7759/cureus.26616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
Abstract
Fournier's gangrene (FG) is necrotizing fasciitis that affects the penis, scrotum, or perineum. Males are more likely to get affected by this disease. The most common predisposing risk factors are diabetes, alcoholism, hypertension, smoking, and immunosuppressive disorders. FG is a polymicrobial infection caused by both aerobic and anaerobic bacteria. The most common aerobic organisms are Escherichia coli, Klebsiella, Proteus, Staphylococcus, and Streptococcus. The most common anaerobic organisms are Bacteroides, Clostridium, and Peptostreptococcus. The disease carries high mortality and morbidity, so timely diagnosis and treatment are of utmost importance. Here, we report a case of a 61-year-old male with a medical history significant for benign prostatic hyperplasia (BPH), who presented to our hospital with fever, watery diarrhea, and painful swelling of the scrotum and penis. The patient was started on piperacillin-tazobactam, vancomycin, and clindamycin. A computed tomography scan of the pelvis showed prostatic enlargement, edema of the penis and scrotum, and air collection within the corpus cavernosum. The patient underwent multiple surgical debridements of the glans penis. Patient wound cultures were positive for Streptococcus anginosus, Actinomyces turicensis, and Peptoniphilus harei. As mentioned earlier, FG is common in diabetic and immunocompromised patients, and infection is usually polymicrobial. Our patient was immunocompetent and his cultures grew atypical organisms.
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Muñoz Rojo A, Cristofori G, Fernández de la Puente E, Gómez-Pavón J. [Fournier's gangrene in an 89-year-old male: An urgent clinical diagnosis]. Rev Esp Geriatr Gerontol 2022; 57:239-240. [PMID: 35760614 DOI: 10.1016/j.regg.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/26/2022] [Accepted: 05/23/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Alicia Muñoz Rojo
- Servicio de Geriatría, Hospital Central de la Cruz Roja, Madrid, España.
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Khokhar F, Hernandez C, Mahapatra R. Fournier’s Gangrene in an HIV-Positive Patient on Empagliflozin for the Treatment of Diabetes Mellitus. Cureus 2022; 14:e26083. [PMID: 35812611 PMCID: PMC9255910 DOI: 10.7759/cureus.26083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/06/2022] Open
Abstract
Fournier's gangrene is a severe polymicrobial infection that results in necrosis of the perineal and genital fasciae with rapid progression. This case report describes a 55-year-old male with a past medical history of HIV, type 2 diabetes, and hypertension who was diagnosed with Fournier's gangrene after the administration of empagliflozin (Jardiance). The patient presented with a worsening ulcer of the right groin and was diagnosed with Fournier’s gangrene based on clinical and radiographic findings. He underwent surgical debridement of the wound. The patient was treated with empiric vancomycin, piperacillin-tazobactam, and clindamycin. Wound cultures grew Streptococcus anginosus and Staphylococcus epidermidis. His antibiotic regimen was simplified to ampicillin-sulbactam. The patient required reconstructive surgery for wound closure after debridement. He received an additional 18 days of augmentin therapy with the resolution of the infectious process. At the time of Fournier’s gangrene onset, the patient's last HbA1C level was 8.2%, despite treatment with glipizide and empagliflozin. This case suggests an association between empagliflozin and Fournier’s gangrene in the setting of active HIV infection.
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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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Mao TC, Zhou X, Tian MN, Zhang YM, Wang SL. A rare case of male Fournier's gangrene with mixed Actinomyces turicensis infection. BMC Urol 2022; 22:25. [PMID: 35197026 PMCID: PMC8867770 DOI: 10.1186/s12894-022-00975-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fournier's gangrene (FG), a urological emergency with high mortality, is an infectious necrotizing fasciitis of the perineal and genital regions. The majority of FG is caused by polymicrobial organisms involving mixed aerobes and anaerobes but rarely reveals Actinomyces species. CASE PRESENTATION We report a healthy 67-year-old Asian male who presented with rapidly progressive painful swelling of the scrotum. Clinically diagnosed with FG, the patient underwent an emergency radical debridement, followed by broad-spectrum antibiotics and negative pressure wound therapy. The identification of the causative microorganisms showed Actinomyces turicensis and the antibiotic treatment was adjusted accordingly. After wound bed preparation, we took split-thickness skin grafts to cover the scrotal wound. Active management to minimize faecal contamination was applied throughout the whole course of treatment and repair. The patient was satisfied with the outcome. This was an extremely rare case of A. turicensis as the main causative pathogen of FG. CONCLUSIONS FG due to Actinomyces species is rarely reported, but we should still consider this pathogenic microorganism that has long been neglected.
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Affiliation(s)
- Tong-Chun Mao
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xuan Zhou
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Meng-Nan Tian
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi-Ming Zhang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shao-Liang Wang
- Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Tarasconi A, Perrone G, Davies J, Coimbra R, Moore E, Azzaroli F, Abongwa H, De Simone B, Gallo G, Rossi G, Abu-Zidan F, Agnoletti V, de'Angelis G, de'Angelis N, Ansaloni L, Baiocchi GL, Carcoforo P, Ceresoli M, Chichom-Mefire A, Di Saverio S, Gaiani F, Giuffrida M, Hecker A, Inaba K, Kelly M, Kirkpatrick A, Kluger Y, Leppäniemi A, Litvin A, Ordoñez C, Pattonieri V, Peitzman A, Pikoulis M, Sakakushev B, Sartelli M, Shelat V, Tan E, Testini M, Velmahos G, Wani I, Weber D, Biffl W, Coccolini F, Catena F. Anorectal emergencies: WSES-AAST guidelines. World J Emerg Surg 2021; 16:48. [PMID: 34530908 PMCID: PMC8447593 DOI: 10.1186/s13017-021-00384-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
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Affiliation(s)
- Antonio Tarasconi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy.
| | - Gennaro Perrone
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Francesco Azzaroli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Hariscine Abongwa
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Belinda De Simone
- Department of Metabolic, Digestive and Emergency Surgery, Centre Hospitalier Intercommunal de Poissy et Saint Germain en Laye, Poissy, France
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Giorgio Rossi
- Emergency Surgery Department, Parma University Hospital, Parma, Italy
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy
| | - Gianluigi de'Angelis
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Nicola de'Angelis
- Minimally Invasive and Robotic Digestive Surgery Unit, Regional General Hospital F. Miulli, Bari, Ital - Université Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- Department of Emergency and general Surgery, Pavia University Hospital, Pavia, Italy
| | - Gian Luca Baiocchi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Carcoforo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Alain Chichom-Mefire
- Faculty of Health Sciences, Department of Surgery, University of Buea, Buea, Cameroon
| | - Salomone Di Saverio
- General surgery 1st unit, Department of General Surgery, University of Insubria, Varese, Italy
| | - Federica Gaiani
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Gastroenterology and Endoscopy Unit, Hospital of Parma, Parma, Italy
| | - Mario Giuffrida
- Department of Medicine and Surgery, General Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michael Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Andrey Litvin
- Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Carlos Ordoñez
- Department of Surgery, Fundacion Valle del Lili - Universidad del Valle, Cali, Colombia
| | | | - Andrew Peitzman
- University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, PA, USA
| | - Manos Pikoulis
- 3rd Department of Surgery, National & Kapodistrian University of Athens, Athens, Greece
| | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Plovdiv, Bulgaria
| | | | - Vishal Shelat
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Edward Tan
- Department of Surgery, Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mario Testini
- Academic Unit of General Surgery "V. Bonomo" Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Imtiaz Wani
- Government Gousia Hospital, Srinagar, Kashmir, India
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Walter Biffl
- Department of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, San Diego, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- General, Emergency and Trauma Surgery Dept., Bufalini Hospital, Cesena, Italy
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Tripodi D, Amabile MI, Gagliardi F, Frusone F, Varanese M, De Luca A, Pironi D, D’ Andrea V, Sorrenti S, Cannistrà C. Algorithm of rational approach to reconstruction in Fournier's disease. Open Med (Wars) 2021; 16:1028-1037. [PMID: 34286099 PMCID: PMC8272539 DOI: 10.1515/med-2021-0294] [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: 02/24/2021] [Revised: 04/02/2021] [Accepted: 04/10/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Fournier's gangrene is a rare form of necrotizing fasciitis that affects the genital area up to the perineal region and sometimes the abdominal wall. OBJECTIVES Our article aims to show that in the treatment of extensive forms of Fournier's gangrene, correct use of flap and skin grafts and a quick reconstruction of the exposed tissues avoid scarring retraction of the testicles and deformation of the penis. MATERIALS AND METHODS We retrospectively reviewed the clinical and photographic data of Fournier's gangrene cases treated at our Institute. The data were evaluated to obtain an estimate of the results of the reconstructive technique used, in terms of percentage of occurred healings and eventual complications. RESULTS A total of 34 patients underwent surgery for Fournier's gangrene. In nine cases (26.5%), we had minor complications: in four patients, suffering from diabetes and obesity, a retard in attachment of graft occurred, while in five patients with perianal problems there was a delay in healing due to the onset of local infection. CONCLUSION The reconstruction approach described here may reduce surgical times. In Fournier's gangrene, the exposed tissues must be reconstructed as quickly as possible.
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Affiliation(s)
- Domenico Tripodi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Federica Gagliardi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Federico Frusone
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Marzia Varanese
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Alessandro De Luca
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Vito D’ Andrea
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, CAP 00161, Italy
| | - Claudio Cannistrà
- Plastic and Reconstructive Surgery Unit, Centre Hospitalier Universitaire Bichat Claude-Bernard, Paris, France
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Oyelowo N, Ahmed M, Lawal AT, Sudi A, Adetola Tolani AMM, Fidelis L, Bello A, Maitama HY. Fournier's gangrene: Presentation and predictors of mortality in Zaria, Nigeria. Ann Afr Med 2021; 20:105-110. [PMID: 34213476 PMCID: PMC8378468 DOI: 10.4103/aam.aam_23_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 01/28/2023] Open
Abstract
Background Fournier's gangrene is an infectious urological emergency with associated morbidity and varying rates of mortality in the world. Various predictors of mortality such as advancing age, Fournier's Gangrene Severity Index (FGSI), anatomical extent of the disease, or presence of risk factors have been studied in the literature, though with conflicting results. Aim The aim of the study was to determine the presentation and predictors of mortality in our environment, Nigeria. Patients and Methods A review of medical records of all the patients managed from April 2012 to December 2018 at a tertiary referral center in Nigeria was conducted. Data on clinical presentation, FGSI, management, and outcome were retrieved and analyzed. Statistical Analysis Descriptive studies using mean and standard deviation were used for continuous variables, Fischer's exact test was used to compare categorical variables among survivors and nonsurvivors, and logistic regression analysis was used to describe the relationships of these variables with mortality. Results The mean age of the 31 patients was 60 ± 12 years. All were men, with 9 (29.0%) patients without clinical evidence of immunosuppression or predisposing factor (idiopathic). Fourteen (45%) had documented evidence of immunosuppression. All the patients had a polymicrobial infection; however, Escherichia coli was the most common organism cultured seen in 26 (83.9%) patients. The initial empirical antibiotic regimen of choice was a combination of intravenous ceftriaxone and metronidazole in 26 (83.8%) patients and intravenous ciprofloxacin and metronidazole in 5 (16.1%) patients. Mortality was recorded in three patients representing a rate of 9.6%. Anatomical extent of the disease, anemia requiring blood transfusion, severity of infection, and FGSI were all found to be the statistically significant variable of mortality in these patients using the Fischer exact test. Furthermore, on regression analysis only the FGSI and blood transfusion were significant with P < 0.05. Conclusion Fournier's gangrene is a disease of the older men with a higher mortality rate when the FGSI is >9 or anemia requiring blood transfusion is present.
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Affiliation(s)
- Nasir Oyelowo
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Muhammed Ahmed
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Ahmad Tijani Lawal
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Abdullahi Sudi
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | | | - Lovely Fidelis
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Ahmad Bello
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Husseini Yusuf Maitama
- Department of Surgery, Division of Urology, Ahmadu Bello University, Zaria, Kaduna, Nigeria
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Duarte I, Outerelo C, Santana A, Guerra J. Fournier Gangrene as a Complication of a Perinephric Abscess After Kidney Transplant: A Case Report. Transplant Proc 2021; 53:1281-1283. [PMID: 33775418 DOI: 10.1016/j.transproceed.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/03/2021] [Indexed: 10/21/2022]
Abstract
Fournier gangrene is a progressive necrotizing infection of the external genitalia or perineum that constitutes a urologic emergency. Incidence of Fournier gangrene is rising because of population aging, increasing comorbidities, and widespread use of immunosuppressive therapy, including immunosuppressive regimens used in kidney transplants. This is a rapidly progressive and potentially lethal disease without treatment, and early recognition of the disease, proper management of the predisposing factors, and aggressive surgical debridement are the most essential interventions. We report a rare case of Fournier gangrene in the early postoperative period of a kidney transplant due to a perinephric abscess.
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Affiliation(s)
- Inês Duarte
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
| | - Cristina Outerelo
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Alice Santana
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José Guerra
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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Ikeda T, Konaka R, Adachi Y, Matsumoto A, Harada N, Wada T, Mitsutsuji M, Samizo M. Perianal abscess due to a long fish bone: a case report. J Surg Case Rep 2021; 2021:rjab084. [PMID: 33777354 PMCID: PMC7984843 DOI: 10.1093/jscr/rjab084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 11/23/2022] Open
Abstract
Few articles have reported cases of perianal abscess due to ingested foreign bodies. Herein, we report a case of perianal abscess due to a long fish bone. A 72-year-old man who was toothless and wore a denture had a chief complaint of anal pain. His left-side buttock had swelling and redness. Computed tomography revealed a perianal abscess on his left-side buttock and high-intensity linear structure in the abscess cavity. We made a diagnosis of perianal abscess due to a fish bone and performed an emergency operation. We opened the abscess cavity and removed the 5 cm fish bone from the cavity. After drainage of the abscess cavity and antibiotic administration, he was discharged from our hospital on day 8. A long fish bone could cause perianal abscesses. Rapid diagnosis and ensuring fish bone removal are important to prevent sepsis.
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Affiliation(s)
- Taro Ikeda
- Correspondence address. Department of Surgery, Sanda City Hospital, 3-1-1 Keyakidai, Sanda, Hyogo 669-1321, Japan. Tel: +81-78-382-5925; Fax: +81-78-382-5939; E-mail:
| | | | - Yukari Adachi
- Department of Surgery, Sanda City Hospital, Hyogo, Japan
| | | | - Naoki Harada
- Department of Surgery, Sanda City Hospital, Hyogo, Japan
| | - Takahiro Wada
- Department of Surgery, Sanda City Hospital, Hyogo, Japan
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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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Féres O, Feitosa MR, da Rocha JJR, Miranda JM, dos Santos LE, Féres AC, de Camargo HP, Parra RS. Hyperbaric oxygen therapy decreases mortality due to Fournier's gangrene: a retrospective comparative study. Med Gas Res 2021; 11:18-23. [PMID: 33642333 PMCID: PMC8103972 DOI: 10.4103/2045-9912.310055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022] Open
Abstract
There is no consensus about the role of adjunctive hyperbaric oxygen therapy (HBOT) in the management of Fournier's gangrene. The aim of this study was to compare the evolution of patients with Fournier's gangrene treated with all classical measures with and without adjuvant HBOT. A retrospective comparative study regarding the evolution of patients treated for Fournier's gangrene was conducted in two periods. In period I, from 1990 to 2002, patients received standard treatments for Fournier's gangrene, which consisted of surgical debridement, antibiotic therapy and intensive care. In period II, from 2012 to 2019, adjunctive HBOT was added to the classical management strategy. All patients were assigned into four groups according to the anatomical severity classification and the area affected after the first debridement. This classification ensured that the groups could be comparable. The total number of patients in this study was 197, and these patients were divided into control group (118/59.9%) and HBOT group (79/40.1%). The mean age, comorbidities, and anatomical severity classification were similar between the two groups. In period I, 34 out of 118 (28.8%) patients died, while in the HBOT group, 3 out of 77 (3.7%) patients died (P < 0.001). The use of adjuvant HBOT in combination with classical treatment was associated with reduced mortality. This study was approved by the Institutional Review Board and the Ethics Committee of Ribeirão Preto Medical School, University of São Paulo, Brazil (No. 08/2018) on May 2, 2018.
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Affiliation(s)
- Omar Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marley Ribeiro Feitosa
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Juliana Mamede Miranda
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Luciana Egydio dos Santos
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Artur Cury Féres
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Hugo Parra de Camargo
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rogério Serafim Parra
- Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Can we predict poor prognosis in Fournier gangrene? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.826917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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El-Qushayri AE, Khalaf KM, Dahy A, Mahmoud AR, Benmelouka AY, Ghozy S, Mahmoud MU, Bin-Jumah M, Alkahtani S, Abdel-Daim MM. Fournier's gangrene mortality: A 17-year systematic review and meta-analysis. Int J Infect Dis 2020; 92:218-225. [PMID: 31962181 DOI: 10.1016/j.ijid.2019.12.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To provide better management of Fournier's gangrene, mortality-associated comorbidities and common etiologies were identified. METHODS A systematic search was conducted using 12 databases, followed by meticulous screening to select relevant articles. Meta-analysis and meta-regression (for possible cofounders) were both done for all possible outcomes. RESULTS Out of 1186 reports screened, 38 studies were finally included in the systematic review and meta-analysis. A higher risk of mortality was detected in patients with diabetes, heart disease, renal failure, and kidney disease, with risk ratios (RR) and 95% confidence intervals (95% CI) of 0.72 (0.59-0.89), 0.39 (0.24-0.62), 0.41 (0.27-0.63), and 0.34 (95% CI 0.16-0.73), respectively. However, there was no association between mortality rates and comorbid hypertension, lung disease, liver disease, or malignant disease (p > 0.05). The highest mortality rates were due to sepsis (76%) and multiple organ failure (66%), followed by respiratory (19.4%), renal (18%), cardiovascular (15.7%), and hepatic (5%) mortality. CONCLUSIONS Modifications to the Fournier's Gangrene Severity Index (FGSI) are recommended, in order to include comorbidities as an important prognostic tool for FG mortality. Close monitoring of the patients, with special interest given to the main causes of mortality, is an essential element of the management process.
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Affiliation(s)
| | | | - Abdullah Dahy
- Faculty of Medicine, Minia University, Minia 61519, Egypt.
| | | | | | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt; Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt.
| | | | - May Bin-Jumah
- Biology Department, College of Science, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
| | - Saad Alkahtani
- Department of Zoology, Science College, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Mohamed M Abdel-Daim
- Department of Zoology, Science College, King Saud University, Riyadh 11451, Saudi Arabia; Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia 41522, Egypt.
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Elbeddini A, Gallinger J, Davey M, Brassard S, Gazarin M, Plourde F, Aly A. A Case of Fournier's Gangrene in a Patient Taking Canagliflozin for the Treatment of Type II Diabetes Mellitus. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920115. [PMID: 32089542 PMCID: PMC7061930 DOI: 10.12659/ajcr.920115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patient: Male, 72-year-old Final Diagnosis: Fournier gangrene Symptoms: Infection • pain • swelling Medication: Canagliflozin Clinical Procedure: Debriment Specialty: Dermatology
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Affiliation(s)
- Ali Elbeddini
- Department of Clinical Pharmacy, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Jodi Gallinger
- Department of Clinical Pharmacy, University of Waterloo Pharmacy School, Waterloo, Ontario, Canada
| | - Michelle Davey
- Department of General Surgery, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Stephane Brassard
- Department of General Medicine, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Mohammed Gazarin
- Research Chief Department, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Frida Plourde
- Department of Infection Control, Winchester District Memorial Hospital, Winchester, Ontario, Canada
| | - Ahmed Aly
- Department of Clinical Pharmacy, Winchester District Memorial Hospital, Winchester, Ontario, Canada
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Evans M, Hicks D, Patel D, Patel V, McEwan P, Dashora U. Optimising the Benefits of SGLT2 Inhibitors for Type 1 Diabetes. Diabetes Ther 2020; 11:37-52. [PMID: 31813092 PMCID: PMC6965597 DOI: 10.1007/s13300-019-00728-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Indexed: 02/06/2023] Open
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitor clinical studies in type 1 diabetes mellitus (T1DM) have demonstrated reduced HbA1c and lower glucose variability with increased time in optimal glucose range as well as additional benefits of reductions in weight and insulin dose without increasing the incidence of hypoglycaemia. However, the appropriate use of SGLT2 inhibitor therapies within clinical practise to treat people with T1DM remains unclear. In this article we have used consensus expert opinion alongside the available evidence, product indication and most recent clinical guidance to provide support for the diabetes healthcare community regarding the appropriate use of SGLT2 inhibitors, focussing on specific considerations for appropriate prescribing of dapagliflozin within the T1DM management pathway. Its purpose is to provide awareness of the issues surrounding treatment with dapagliflozin in T1DM as well as offer practical guidance that also includes a checklist tool for appropriate dapagliflozin prescribing. The checklist aims to support clinicians in identifying those people with T1DM most likely to benefit from dapagliflozin treatment as well as situations where caution may be required.Funding: AstraZeneca UK Ltd.
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Affiliation(s)
- Marc Evans
- Diabetes Resource Centre, University Hospital Llandough, Cardiff, UK.
| | | | - Dipesh Patel
- Department of Diabetes, Division of Medicine, University College London, Royal Free NHS Trust, London, UK
| | - Vinod Patel
- Warwick Medical School, University of Warwick, George Eliot Hospital NHS Trust, Nuneaton, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd., Cardiff, UK
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Nagano Y, Yakame NK, Aoki H, Yamakawa T, Kondo NI. Fournier's Gangrene in a Patient with Type 2 Diabetes Mellitus Treated with Empagliflozin: A Case Report. DRUG SAFETY - CASE REPORTS 2019; 6:11. [PMID: 31628552 PMCID: PMC6800415 DOI: 10.1007/s40800-019-0105-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been reported as possibly associated with Fournier’s gangrene (FG). This case report describes a 34-year-old Japanese man who was diagnosed with FG after the administration of empagliflozin for type 2 diabetes mellitus (T2DM). He presented with pain and swelling in the perineum and groin 142 days after initiating empagliflozin. The clinical features, laboratory data, and computed tomographic findings were consistent with FG. Surgical drainage and debridement of necrotic tissues were performed immediately after admission to our hospital. The patient had no complications of diabetes before the onset of FG. Glycemic management was good at the time of FG onset. This case suggests a possible association between empagliflozin and FG. We report a case of FG in a patient during a period of good glycemic management following treatment with empagliflozin. We recommend further awareness of this relationship and suggest the need for additional research.
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Affiliation(s)
- Yasunori Nagano
- Department of Pharmacy, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan.
| | - Naomi Kashiwagi Yakame
- Department of Pharmacy, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
| | - Hisae Aoki
- Department of Surgery, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
| | - Tamaki Yamakawa
- Department of Endocrinology and Metabolism, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
| | - Naoko Iwahashi Kondo
- Department of Surgery, Sanraku Hospital, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 1018326, Japan
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Fournier Gangrene: A Review for Emergency Clinicians. J Emerg Med 2019; 57:488-500. [PMID: 31472943 DOI: 10.1016/j.jemermed.2019.06.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Fournier gangrene (FG) is a rare, life-threatening infection that can result in significant morbidity and mortality, with many patients requiring emergency department (ED) management for complications and stabilization. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of FG. DISCUSSION Although originally thought to be an idiopathic process, FG has been shown to have a strong association for male patients with advanced age and comorbidities affecting microvascular circulation and immune system function, most commonly those with diabetes or alcohol use disorder. However, it can also affect patients without risk factors. The initial infectious nidus is usually located in the genitourinary tract, gastrointestinal tract, or perineum. FG is a mixed infection of aerobic and anaerobic bacterial flora. The development and progression of gangrene is often fulminant and can rapidly cause multiple organ failure and death, although patients may present subacutely with findings similar to cellulitis. Laboratory studies, as well as imaging including point-of-care ultrasound, conventional radiography, and computed tomography are important diagnostic adjuncts, though negative results cannot exclude diagnosis. Treatment includes emergent surgical debridement of all necrotic tissue, broad-spectrum antibiotics, and resuscitation with intravenous fluids and vasoactive medications. CONCLUSIONS FG requires a high clinical level of suspicion, combined with knowledge of anatomy, risk factors, and etiology for an accurate diagnosis. Although FG remains a clinical diagnosis, relevant laboratory and radiography investigations can serve as useful adjuncts to expedite surgical management, hemodynamic resuscitation, and antibiotic administration.
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Bloomgarden Z, Einhorn D, Grunberger G, Handelsman Y. Fournier's gangrene and sodium-glucose cotransporter 2 inhibitors: Is there a causal association? J Diabetes 2019; 11:340-341. [PMID: 30600643 DOI: 10.1111/1753-0407.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel Einhorn
- University of California San Diego and Scripps Whittier Institute for Diabetes, San Diego, California
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Pehlivanlı F, Aydin O. Factors Affecting Mortality in Fournier Gangrene: A Single Center Experience. Surg Infect (Larchmt) 2019; 20:78-82. [DOI: 10.1089/sur.2018.208] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Faruk Pehlivanlı
- Faculty of Medicine, Department of General Surgery, Kirikkale University, Kirikkale, Turkey
| | - Oktay Aydin
- Faculty of Medicine, Department of General Surgery, Kirikkale University, Kirikkale, Turkey
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Which Method Is Better to Provide Wound Healing in Fournier Gangrene: Dakin Solution or Conventional Antiseptic Dressings? A Retrospective Study. Int Surg 2019. [DOI: 10.9738/intsurg-d-16-00029.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Fournier gangrene is described as necrotizing fasciitis involving the genital, perineal, and perianal area. Early surgical debridement of necrotic tissues, topical therapy, and antibiotics are fundamental in the treatment of Fournier gangrene. We aimed to compare the effects of Dakin solution and povidone iodine solution on patient outcomes by using the Fournier gangrene severity index (FGSI). The demographic data, comorbid diseases, local therapeutic interventions, FGSI, necessity of diverting colostomy or orchiectomy, hospitalization time, number of debridements, complications, and outcomes of 57 patients with Fournier gangrene were retrospectively analyzed. A total of 47 of 57 patients (82.5%) were male, and 10 patients (17.5%) were female, with a mean age of 62.3 ± 13.8 years (range, 27–85 years). The survivors were significantly younger than the nonsurvivors. The mean FGSI score was 4 (range, 1–9) in survivors, and mean FGSI score was 9 (range, 6–10) in nonsurvivors. FGSI score was significantly higher in the mortality group. The median hospital stay was 13 days (range, 3–34 days) in the Dakin solution group and 20 days (range, 1–41 days) in the povidone iodine group. Overall mortality rate was 17.5%. Advanced age had a statistically significant effect on mortality. The hospitalization time was significantly shorter in the Dakin solution group, and use of Dakin solution decreased the number of debridements. Dakin solution has favorable effects on hospital stay and the necessity of multiple debridements. Dakin solution seems to be a good and cost-effective choice for treatment in local wound healing.
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Sartelli M, Guirao X, Hardcastle TC, Kluger Y, Boermeester MA, Raşa K, Ansaloni L, Coccolini F, Montravers P, Abu-Zidan FM, Bartoletti M, Bassetti M, Ben-Ishay O, Biffl WL, Chiara O, Chiarugi M, Coimbra R, De Rosa FG, De Simone B, Di Saverio S, Giannella M, Gkiokas G, Khokha V, Labricciosa FM, Leppäniemi A, Litvin A, Moore EE, Negoi I, Pagani L, Peghin M, Picetti E, Pintar T, Pupelis G, Rubio-Perez I, Sakakushev B, Segovia-Lohse H, Sganga G, Shelat V, Sugrue M, Tarasconi A, Tranà C, Ulrych J, Viale P, Catena F. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg 2018; 13:58. [PMID: 30564282 PMCID: PMC6295010 DOI: 10.1186/s13017-018-0219-9] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/22/2018] [Indexed: 02/08/2023] Open
Abstract
Skin and soft-tissue infections (SSTIs) encompass a variety of pathological conditions that involve the skin and underlying subcutaneous tissue, fascia, or muscle, ranging from simple superficial infections to severe necrotizing infections. SSTIs are a frequent clinical problem in surgical departments. In order to clarify key issues in the management of SSTIs, a task force of experts met in Bertinoro, Italy, on June 28, 2018, for a specialist multidisciplinary consensus conference under the auspices of the World Society of Emergency Surgery (WSES) and the Surgical Infection Society Europe (SIS-E). The multifaceted nature of these infections has led to a collaboration among general and emergency surgeons, intensivists, and infectious disease specialists, who have shared these clinical practice recommendations.
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Affiliation(s)
| | - Xavier Guirao
- Unit of Endocrine, Head, and Neck Surgery and Unit of Surgical Infections Support, Department of General Surgery, Parc Taulí Hospital Universitari, Sabadell, Spain
| | - Timothy C. Hardcastle
- Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R Mandela School of Clinical Medicine, Durban, South Africa
| | - Yoram Kluger
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Kemal Raşa
- Department of Surgery, Anadolu Medical Center, Kocaali, Turkey
| | - Luca Ansaloni
- General Surgery Department, Bufalini Hospital, Cesena, Italy
| | | | - Philippe Montravers
- Anesthesiology and Critical Care Medicine, Paris Diderot Sorbonne Cite University, Bichat-Claude Bernard University Hospital, HUPNSV, Paris, France
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Matteo Bassetti
- Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Intergrata di Udine, Udine, Italy
| | - Offir Ben-Ishay
- Department of General Surgery, Division of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter L. Biffl
- Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA USA
| | - Osvaldo Chiara
- General Surgery-Trauma Team, State University of Milano, Niguarda Hospital Milano, Milan, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit, State University of Pisa, Cisanello Hospital, Pisa, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center and Loma Linda University School of Medicine, Moreno Valley, CA USA
| | | | - Belinda De Simone
- Unit of General, Emergency and Trauma Surgery, Regional Hospital of Perpignan, Perpignan, France
| | - Salomone Di Saverio
- Department of Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - George Gkiokas
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | | | - Ari Leppäniemi
- Abdominal Center, University Hospital Meilahti, Helsinki, Finland
| | - Andrey Litvin
- Department of Surgical Disciplines, Immanuel Kant Baltic Federal University, Regional Clinical Hospital, Kaliningrad, Russian Federation
| | - Ernest E. Moore
- Department of Surgery, University of Colorado, Denver Health Medical Center, Denver, CO USA
| | - Ionut Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Maddalena Peghin
- Infectious Diseases Division, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Intergrata di Udine, Udine, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Parma, Parma, Italy
| | - Tadeja Pintar
- Department of Surgery, UMC Ljubljana, Ljubljana, Slovenia
| | - Guntars Pupelis
- Department of General and Emergency Surgery, Riga East University Hospital ‘Gailezers’, Riga, Latvia
| | - Ines Rubio-Perez
- General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital, Madrid, Spain
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Helmut Segovia-Lohse
- Second Department of Surgery, Hospital de Clínicas, Universidad Nacional de Asuncion, San Lorenzo, Paraguay
| | - Gabriele Sganga
- Emergency Surgery (or Division of Emergency Surgery), Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vishal Shelat
- General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Antonio Tarasconi
- Department of Emergency Surgery, Parma Maggiore Hospital, Parma, Italy
| | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Jan Ulrych
- First Department of Surgery, Department of Abdominal, Thoracic Surgery and Traumatology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Fausto Catena
- Emergency Surgery (or Division of Emergency Surgery), Fondazione Policlinico Universitario A. Gemelli IRCCS – Università Cattolica del Sacro Cuore, Rome, Italy
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Hahn HM, Jeong KS, Park DH, Park MC, Lee IJ. Analysis of prognostic factors affecting poor outcomes in 41 cases of Fournier gangrene. Ann Surg Treat Res 2018; 95:324-332. [PMID: 30505824 PMCID: PMC6255751 DOI: 10.4174/astr.2018.95.6.324] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/14/2018] [Accepted: 06/29/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes. Methods The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. The severity index and score were calculated. Multivariate regression analysis was used to determine the association between potential predictors and clinical outcomes. Results A total of 41 patients (male:female = 33:8) were studied. The mean age was 54.4 years (range, 24-79 years). The most common predisposing factor was diabetes mellitus (n = 19, 46.3%). Sixteen patients (39.0%) were current smokers. Seven patients had chronic kidney disease. The most frequent etiology was urogenital lesion (41.5%). The mortality rate was 22.0% (n = 9). Multivariate regression analyses showed that extension of necrosis beyond perineal/inguinal area and pre-existing chronic kidney disease were significant and independent predictors of mortality. Extension of necrosis beyond perineal/inguinal area was a significant predictor of increased duration in the intensive care unit and hospital stay. In addition, pre-existing chronic kidney disease was a significant predictor of flap reconstruction in the wound. Conclusion Fournier gangrene with extensive soft tissue necrosis and pre-existing chronic kidney disease was associated with poor prognosis and complexity of patient management. Early recognition of dissemination and premorbid renal function is essential to reduce mortality and establish a management plan for this disease.
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Affiliation(s)
- Hyung Min Hahn
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Kwang Sik Jeong
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Dong Ha Park
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Myong Chul Park
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Il Jae Lee
- Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea
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Sockkalingam VS, Subburayan E, Velu E, Rajashekar ST, Swamy AM. Fournier's gangrene: prospective study of 34 patients in South Indian population and treatment strategies. Pan Afr Med J 2018; 31:PAMJ-31-110. [PMID: 31037161 PMCID: PMC6462357 DOI: 10.11604/pamj.2018.31.110.15495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/04/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction Fournier's gangrene (FG) is a fulminant necrotizing fasciitis of the perineum and genitalia. The objective of this study was to study the etiology and microbiology associated with FG and to study the debridement and reconstructive procedures required in these patients. Methods This was a prospective follow up study conducted from September 2011 to November 2012 at Coimbatore medical college hospital, Coimbatore, India. Patients presenting to the outpatient department and emergency department with the clinical diagnosis of FG were included in the study. Results A total of 34 patients were studied in the study period. The mean age of presentation in years was 50±11.13. The male to female ratio was 33:1. The source of the infection was most commonly anorectal. Diabetes mellitus was the most common co morbid factor associated. Most commonly the disease was polymicrobial with escherichia coli being the commonest grown organism. The average number of wound debridement required was 2.9±1.42. Primary closure of the scrotal skin defect was the most common reconstructive procedure performed. Mortality associated with the disease in our series was 11.8%. Conclusion Although FG is a relatively rare disease, it is still prevalent in Indian population. Incidence of FG in HIV patients is high, even though it is not the commonest of the co morbid condition. The mortality can be kept to minimal with aggressive medical and surgical management. Extensive raw area following the infection and wound debridement can be managed by simple reconstructive procedures with good outcome.
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Affiliation(s)
| | | | - Elango Velu
- Department of Surgery, Coimbatore Medical College, Coimbatore, India
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