Presentation of fournier’s gangrene cases and proper management

Abstract

Introduction. Fournier’s gangrene is a serious and potentially lethal rare infection of perineal and external genital with priority to be be treated as a medical and surgical emergency. It consists of a rapidly progressive necrotizing fasciitis in the genital, perineal, and perianal region produced by aerobic and anaerobic microorganisms acting synergistically. This disease normally affects males between 50 and 70 years of age with concomitant diseases. It is a disease with high morbidity and mortality (3%-76%), the treatment of which is based on early and radical surgical debridement, broad-spectrum antibiotic therapy, and daily dressing changes which allows for evaluation of the need for subsequent debridement. Aim of the study. The aim of this study is to highlight the particularities, dynamics, severity and necessity of the rapid management of this disease in the last 5 years around the world in the help of young medical professionals in my country. Materials and methods. I presented a descriptive and retrospective chart review of patients diagnosed and treated for this pathology over the last 5 years. The patient age, sex, risk factors, laboratory investigations, presenting symptoms, duration of hospital stay, microbiological findings, associated diseases were recorded. The culture was extracted from the pus zone of the abscess. Results. 3 patients were highlighted with this condition. The average age was 58 years. The clinical presentation was similar; it started as a perianal or perineal phlegmon/abscess with later locoregional dissemination. Fournier gangrene was suspected in all patients prior to surgical treatment, due to both the clinical examination and the imaging tests that were performed. Computed tomography (CT) was performed on admission in all 3 cases; all the cases demonstrated subcutaneous emphysema and multiple air bubbles in the perineum, perianal region and in the ischiocavernosus and bulbospongiosus muscles. A single debridement was sufficient for all the 3 patients. The average stay was 30 days.The infection was polymicrobial in all patients .The organism most frequently isolated was Escherichia coli. Multiple antibiotic therapy was used in all patients. Conclusions. Fournier gangrene has an elevated morbidity and mortality caused by polymicrobial flora with a varied etiology which presents in patients with risk factors. Early diagnosis and rapid, thorough debridement is the most important factor in the management of this disease.