Hernández-Sampelayo GM, del Olmo-Bautista S, López-Menéndez AM, Cortiñas-Díez I

Language: Spanish
References: 0
Page: 755-761
PDF size: 180.38 Kb.

ABSTRACT

Background: Fournier´s gangrene is a polymicrobial necrotizing fasciitis, with acute onset and rapid progression. It affects perineal, perianal and genital regions and it has a high mortality rate. It is 10 times more frequent in men than in women, with highest incidence amongst patients aged 50 to 60. Its known risk factors include diabetes mellitus, hypertension and alcoholism.
Clinical case: A 62-year-old woman with type II long-standing diabetes mellitus, hypertension and obesity, without previous gynecological exams was hospitalized with fever, abdominal and perineal pain. She was diagnosed with vulvar FG, probably caused by a vulvar erosion, produced by the total genital prolapse presented. Exploration (crepitant vulvar abscess) and imaging tests helped the diagnosis. Broad-spectrum intravenous antibiotics therapy was initiated, followed by an urgent surgical procedure in which a debridement of the necrotic tissue was performed. Due to spreading of the infection, the patient had to be reoperated 48 hours later. Streptococcus Constelatus and anaerobes were isolated from tissues and an anatomopathological study confirmed the diagnosis. Postoperative care ended favorably.
Conclusions: Fournier’s gangrene constitutes a very rare pathology, especially in women due to a more insidious clinic. Knowing about the risk factors and initial symptoms, can help to make an early diagnosis and apply urgent treatment, allowing more conservative surgeries, increasing the survival and improving the prognosis. The right handling of diabetes, its main risk factor, becomes key in the prevention of this pathology.