medigraphic.com

2005, Number 5

<< Back Next >>

Cir Cir 2005; 73 (5)

Synergistic necrotizing fasciitis of the anoperineal and external genitalia: Progression to Fournier’s gangrene?

Sierra-Luzuriaga G, Sierra-Montenegro E, Cruz-Lavallen V

Language: Spanish
References: 38
Page: 369-373
PDF size: 101.08 Kb.


ABSTRACT

Introduction: In 1883, Fournier, a French venereal disease physician, described five patients with fulminant surgical infection of the male genitalia. He pointed to three main features: 1) sudden onset, 2) rapid gangrene progression, and 3) no visible cause. Since then, multiple primary causes have been identified such as genitourinary infections, local trauma, different surgical procedures or instruments, as well as acute anorectal disease (ischiorectal abscesses). We describe the experience with patients diagnosed with Fournier’s Syndrome or necrotizing anoperineal and genital infection in our hospital service.
Material and methods: Medical files were reviewed from the Proctology Department of the IESS Regional Hospital from January 1, 1980 to May 15, 2004. The method was descriptive, retrospective and longitudinal. Results: Fifty one predominantly male patients (48 males and 3 females) with a mean age of 49 years were studied. Symptoms were present for 8.7 days. The most common associated disease was diabetes mellitus (24 patients). Cultures were only used for anaerobes and mainly E. coli was identified. Extensive incisions, continuous debridement and necrotic tissue removal were included in the surgical procedure as many times as necessary. There was progression in the abdominal wall and the inguinal region. Orchidectomy and diversion colostomy were performed in 10 patients. Average hospital stay was 32 days. Antibiotic treatment was used against aerobes and anaerobes. Eight patients died (15.5%).
Conclusions: In these patients local resistance is disturbed and cell immunity is impaired. Also, the nutritional and vascular condition of patients is affected because of aerobe/anaerobe bacterial synergy. It is recommended to immediately start pus drainage, incise even hyperemic tissue, and debride and resect necrotized tissue several times to avoid residual infection and sepsis.


REFERENCES

  1. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg 2000;87:718-728.

  2. Stephens B, Lathrop J, Rice W, Gruenberg J. Fournier’s gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance. Am Surg 1993;59:149-154.

  3. Meleney F. Hemolytic streptococcus gangrene. Arch Sur g 1924;9: 317-364.

  4. Wilson B. Necrotizing fascitis. Am Surg 1952;18:416–431.

  5. Gray JA. Gangrene of the genitalia as seen in advanced periurethral extravasation with phlegmon. J Urol 1960;84:740–745.

  6. Bubrick MP, Hitchcock CR. Necrotizing anorectal and perineal infections. Surgery 1979;86:655-662.

  7. Enriquez JM, Moreno S, Devesa M, Morales V, Platas A, Vicente E. Fournier’s syndrome of urogenital and anorectal origin. A retrospective, comparative study. Dis Colon Rectum 1987;30:33-37.

  8. Laucks SS. Fournier’s gangrene. Surg Clin North Am 1994;74:1339-1352.

  9. Sutherland ME, Meyer AA. Necrotizing soft tissue infections. Surg Clin North Am 1994;74:591-607.

  10. Gould SWT, Banwell P, Glazer G. Perforated colonic carcinoma present-ing as epididimoorchitis and Fournier’s gangrene. Eur J Surg Oncol 1997;23:367-371.

  11. Berg A, Armitage JO, Burns CP. Fournier gangrene complicating aggressive therapy for hematologic malignancy. Cancer 1986;57: 2291-2294.

  12. Ong HS, Ho YH. Genitoperineal gangrene: experience in Singapore. Aust N Z J Surg 1996;66:291-293.

  13. Kouadio K, Kouame YJ, Bi KL, Turquin HH. Perineal gangrene: report of 30 cases observed at Abidjan. Med Trop 1998;58:245-248.

  14. Vick R, Carson CC III. Infection in urology: Fournier’s disease. Urol Clin North Am 1999;26:841-849.

  15. Smith GL, Bunker CB, Dinneen MD. Fournier’s gangrene. Br J Urol 1998;81:347-355.

  16. Baskin LS, Carroll PR, Cattolica EV, McAninch JW. Necrotising soft tissue infections of the perineum and genitalia. Br J Urol 1990;65:524-529.

  17. Malangoni MA. Necrotizing soft tissue infections: are we making any progress? Surg Infect 2001;2:145-152.

  18. Paty R, Smith AD. Gangrene and Fournier’s gangrene. Urol Clin North Am 1992;19:149-162.

  19. Gerber GS, Guss SP, Pielet RW. Fournier’s gangrene secondary to intraabdominal process. Urology 1994;44:779-782.

  20. Hejase MJ, Simonin JE, Bihrle R, et al. Genital Fournier’s gangrene: experience with 38 patients. Urology 1996;47:734-739.

  21. Asci R, Sarikaya S, Buyukalpelli R, et al. Fournier’s gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application. Eur Urol 1998;34:411-418.

  22. Basoglu M, Gül O, Yildirgan I, et al. Fournier’s gangrene: review of fifteen cases. Am Surg 1997;63:1019-1021.

  23. Hollabaugh RS Jr, Dmochowski RR, Hickerson WL, et al. Fournier’s gangrene therapeutic impact of hyperbaric oxygen. Plast Reconstr Surg 1998;101:94-100.

  24. Korhonen K, Hirn M, Niinikoski J. Hyperbaric oxygen in treatment of Fournier’s gangrene. Eur J Surg 1998;164:251-255.

  25. Olsofka JN, Carrillo EH, Spain DA, et al. The continuing challenge of Fournier’s gangrene in the 1990s. Am Surg 1999;65:1156-1159.

  26. Savino C, Harford FJ, Dobrin PB. Necrotizing infections of the perineum. South Med J 1993;86:908-911.

  27. Yaghan RJ, Al-JAberi TM, Bani-Hani I. Fournier’s gangrene. Changing face of the disease. Dis Colon Rectum 2000;43:1300-1308.

  28. Benizri E, Fabiani P, Migliori G, et al. Gangrene of the perineum. Urology 1996;47:935-939.

  29. Brissiaud JC, Azam P, Paret B, Lopy J, Louis C, Coller F. Skin gan-grene of the external genitalia. Report of 44 cases. Chirurgie 1998; 123:787-793.

  30. Pizzorno R, Bonini F, Donelli A, Stubinski R, Medica M, Carmignami G. Hyperbaric oxygen therapy in the treatment of Fournier’s disease in 11 male patients. Br J Urol 1997;158:837-840.

  31. el Khader K, el Fassi J, Nouri M, Ibn Attya A, Hachimi M, Lakrissa A. Four-nier’s gangrene. Analysis of 32 cases. J Urol (Paris) 1997;103:32-34.

  32. Benchekroun A, Lachkar A, Bjijou Y, et al. Gangrene of the external genital organs. Apropos of 55 cases. J Urol 1997;103:27-31.

  33. Picramenos D, Deliveliquis C, Macrichorius K, Alexopoulou K, Kostakopoulos A, Dimopoulos C. Fournier’s gangrene: etiology, treatment and complications. Prog Urol 1995;57:701-705.

  34. Palmer Ls, Winter HI, Tolia BM, Reid RE, Laor E. The limited impact of involved surface area on survival in Fournier’s gangrene. Br J Urol 1995;76:208-212.

  35. Attah CA. New approach to the management of Fournier’s gangrene. Br J Urol 1992;70:78-80.

  36. Clayton MD, Fowler JE, Sharifi R, Pearl RK. Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet 1990; 170:49-55.

  37. Wolach MD, MacDermott JP, Stone AR, deVere White RW. Treatment and complications of Fournier’s gangrene. Br J Urol 1989;64: 310-314.

  38. Fahal AH, Hassan MA. Fournier’s gangrene in Khartoum. Br J Urol 1988;61:451-454.




2020     |     www.medigraphic.com