Fournier’s Gangrene: Review of 36 Cases

Abstract

Introduction: The mortality rate of Fournier's gangrene remains high despite antibiotics and aggressive surgical debridement. In this study we aimed to define the factors that have impact on mortality in Fournier's gangrene. Materials and Methods: Between January 1996 and August 2005, thirty eight patients with Fournier's gangrene were treated in our clinic. Patients' records were investigated retrospectively. The variables such as age, etiological and predisposing factors and time interval until admission to hospital were evaluated. The diagnosis was done according to a detailed history and physical findings on admissions. Antibiotics were administered and emergent surgical debridement was performed to all patients. Results: There were 37 male and 1 female patient in the whole group. The mean age was calculated as 51.9 years (range: 24-76 years). The overall mortality rate was 21% (8/38). Sex of the patients had no effect on mortality (p > 0.05). The mean age in exitus group was statistically higher than the other patients (67.3 year (range, 58-76) vs 47.9 year (range, 24-70), p=0,01). The mean time interval between onset of symptoms and admission to hospital was 7.3 days (range, 2-15 days). There was no difference between patients who were lost and patients who survived according to this time interval (8.4 days (range, 3-15 days) vs 7 days (3-15 days), p=0.306). Etiologic factors were perianal abcess in six patients, anorectal surgery in 5 patients, abdominal surgery in 3 patients, spontaneous rupture of urethra in 1 patients and history of pelvic radiation therapy because of prostate cancer in 1 patient. None of these factors had any impact on mortality (p > 0.05). Three patients were being followed with indwelling urethral catheters because of neurogenic bladder. Diabetes mellitus was found as predisposing factor in 8 patients. None of these predisposing factors had any impact on mortality (p > 0.05). On admission 3 patients were in coma and these 3 patients were lost after surgical debridement (p=0.007). Of the survivors, 13 of 30 patients underwent local advancement flap reconstruction by plastic surgery. A diverting colostomy was performed in 11 patients and was closed in 9 patients who survived 3 months after discharge from the hospital. Conclusion: Fournier's gangrene remains a surgical emergency and increased patient age and being in comatose state on admission seems to be the most important prognostic factor with a significant impact on outcome.