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2008, Number 3

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Cir Gen 2008; 30 (3)

Usefulness of colostomy en Fournier’s gangrene and its mortality predictive value

Jiménez BB, Santillán RJH, Legorreta CCI, Villanueva HJA, Charúa L

Language: Spanish
References: 28
Page: 141-148
PDF size: 789.31 Kb.


ABSTRACT

Objective: To assess the traditionally known indications for colostomy in cases of Fournier gangrene and compare them with the observations made in a group of patients. To validate the requirement for colostomy as a prognostic indicator of mortality.
Setting: Coloproctology Unit of the General Hospital of Mexico.
Design: Retrospective, observational, and analytical.
Statistics: Two way Student’s t test and chi-square test.
Patients and methods: The clinical records of the patients admitted with a diagnosis of Fournier gangrene from October 2001 to October 2007 were reviewed. We analyzed whether or not colostomy was performed, the Laor severity scale, and mortality.
Results: The study comprised 208 patients, 171 men (82.21%) and 37 women (17.79%), from 18 to 92 years of age. We formed two groups. Group 1 (n = 66, 31.73%) subjected to colostomy, 27 (40.90%) due to incontinence and 19 (28.78%) due to large extension. In 20 (30.30%) no indication was specified. No patient with severe immunodeficiency or rectal perforation was included in this group. Clinical incontinence was confirmed in 25 (92.59%). In the 19 cases due to large extension, the affected body surface was in average of 7.21%. Group 2 (n = 142, 68.29%) was managed without colostomy, with an average body surface of 6.53%. Non of the seven patients with severe immunodeficiency was subjected to colostomy. Global mortality was of 42 (22.11%); 34 (80.95%) patients scored more than 9 points in the Laor scale, and 57 (86.36%) patients survived of those subjected to colostomy survived.
Conclusion: The need of colostomy is not a predictor of mortality. The large extension and severe immunodeficiency are not determinants to decide on performing a colostomy. Rectal perforation is very rare, but, if present, must be taken into account, evaluating each case in particular.


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