Fuentes VE, Núñez RA, Kapaxi AJ, Fernandes CY

Language: Spanish
References: 23
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PDF size: 111.43 Kb.

ABSTRACT

Introduction: Fournier's gangrene is a rare and serious disease, which is characterized by necrotizing, synergistic and polymicrobial fasciitis and maintains high mortality.
Objective: to contribute to a better knowledge about the individual diagnosis, treatment and prognosis of this rare disease.
Methods: Seven patients who were treated from February 2010 to April 2011 were studied. Demographic data, associated diseases, etiology, treatment, complications and mortality were evaluated as well as the time with probe and hospital stay.
Results: the patients were men with a mean age of 43, 3 years; the youngest was 30 years old and the oldest was 49. The associated diseases were: acquired immunodeficiency syndrome (2), diabetes mellitus (1), and hypertension (1). The origins were perineal (4) and scrotal (3). Three patients reported to have perineal fistulas or abscesses. The time of evolution fluctuated between 6 and 30 days. Clinical manifestations were characterized by pain, increase in volume in perineal or scrotal regions or both and fetid secretion. Crepitation was found when the disease occupied the inguinal regions and the abdominal wall. Surgical treatment required debridement and digestive derivations (colostomy), urinary derivations (cytostomy) or both. The number of interventions varied between three and seven. Surgical reconstruction of the perineum and scrotum was practiced, using skin grafts in the survivors. Three patients (42.9 %) presented complications: septic shock, multiple organ failure and late urethral stricture (1). A patient who had been admitted with manifestations of septic shock died (14.3 %).
Conclusions: the success of the treatment is achieved with the early diagnosis, early aggressive surgical debridement, and broad-spectrum antibiotic therapy.

REFERENCES

1. Lin E, Yang S, Chiu AW, Chow YC, Chen M, Lin WC, et al. Is Fournier´s gangrene index useful for predicting outcome of Fournier´s gangrene? Urol Int. 2005;75(2):119- 22.

2. Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB. Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg. 2002;68(8):709-13.

3. Fabiani P et Benizri E. Traitement chirurgical des gangrènes du périnée. Encycl. Méd Chir. (Elsevier, Paris-France), Techniques chirurgicalesAppareil digestif, 695. 1998;(40):1-6.

4. Baurienne H: Sur une plaie contuse qui's est terminee par le sphacele de le scrotum. J Med Chir Pharm. 1764;20:251-6.

5. Fournier JA. Gangrene foudroyante de la verge. Medecin Pratique. 1883;4:589-97.

6. Jonasson O. Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 15th ed. Chapter 10. Philadelphia: W B Saunders Company; 1997. p. 176-85.

7. Olumi AF and Richie JP. Sabiston Textbook of Surgery. The Biological Basis of Modern Surgical Practice. 18th ed. Chapter 77. Philadelphia: Saunders Elseviers; 2008. p. 2251-86.

8. Sánchez Mazzaferri F, Fadil Iturralde JL, Provenzal O, Damiani H, Milman A, Bragagnolo et al. Fournier's gangrene. Our experience over 10 years. A review of the literature. J Arch Esp Urol. 1999;52(7):721-7.

9. Efem SE. The features and aetiology of Fournier's gangrene. Postgrad Med J. 1994;70(826):568-71.

10. Martínez-Rodríguez R, Ponce de León J, Caparrós J, Villavicencio H. Fournier's gangrene: a monographic urology center experience with twenty patients. Urol Int. 2009;83(3):323-8.

11. Kara E, Müezzinoðlu T, Temeltas G, Dinçer L, Kaya Y, Sakarya A, Coskun T. Evaluation of risk factors and severity of a life threatening surgical emergency: Fournier's gangrene (a report of 15 cases). Acta Chir Belg. 2009;109(2):191-7.

12. Anchi T, Tamura K, Inoue K, Satake H, Ashida S, Nishikawa H, et al. Experience in the treatment of eight cases of Fournier's gangrene. Hinyokika Kiyo. 2009;55(9):545- 9.

13. Tuncel A, Aydin O, Tekdogan U, Nalcacioglu V, Capar Y, Atan A. Fournier's gangrene: Three years of experience with 20 patients and validity of the Fournier's Gangrene Severity Index Score. Eur Urol. 2006;50(4):838-43.

14. Morua AG, Lopez JA, Garcia JD, Montelongo RM, Guerra LS. Fournier's gangrene: our experience in 5 years, bibliographic review and assessment of the Fournier's gangrene severity index. Arch Esp Urol. 2009;62(7):532-40.

15. Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O. Fournier's gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006;13(7):960-7.

16. Fahal AH, Hassan MA. Fournier's gangrene in Khartoum. Br J Urol. 1988;61(5):451-4.

17. Thadepalli H, Rao B, Datta NK, and Zinner N. La formación de gas no es común en esta enfermedad. Polymicrobial genital gangrene (Fournier´s Gangrene): clinical, microbiologic and therapeutic features. J Nat Med Assoc. 1983;74(2): 273-7.

18. Ersay A, Yilmaz G, Akgun Y, Celik Y. Factors affecting mortality of Fournier's gangrene: review of 70 patients. Anz J Surg. 2007;77(1-2):43-8.

19. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier's gangrene. J Urol. 1995;154(1):89-92.

20. Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology. 2004;64(2):218-22.

21. Uluð M, Gedik E, Girgin S, Celen MK, Ayaz C. The evaluation of microbiology and Fournier's gangrene severity index in 27 patients. Int J Infect Dis. 2009 Nov;13(6):e424-30.

22. López-Sámano V, Ixquiac-Pineda G, Maldonado-Alcaraz E, Montoya-Martínez G, Serrano-Brambila E, Peralta-Alarcón J. Fournier's gangrene. Experience of the CMN SXXI Hospital. Arch Esp Urol. 2007;60(5):525-30.

23. Canbaz H, Caðlikülekçi M, Altun U, Dirlik M, Türkmenoðlu O, Taºdelen B, Aydin S. Fournier's gangrene: analysis of risk factors affecting the prognosis and cost of therapy in 18 cases. Ulus Travma Acil Cerrahi Derg. 2010;16(1):71-6.