Title: Surgical Management and Outcomes of Fournier’s Gangrene: An Experience with 78 Cases
Authors: Dr Ridhika Munjal, Dr Mrs. V.J. Thipse, Dr J.M. Gadekar, Dr Niranjan Dash, Dr Arvind Kumar Prabhat, Dr S.T. Bhondave
DOI: https://dx.doi.org/10.18535/jmscr/v6i2.50
Abstract
Fournier’s gangrene is the surgical emergency condition. Early diagnosis and its management is the need of hour for high surgical outcomes.
Aim and Objective: Early diagnosis, surgical management and outcomes of fournier’s gangrene.
Materials and Methods: We prospectively analysed 78 cases of Fournier’s gangrene during the study period of July 2015 to July 2017 at DVVPF's Medical College and Hospital, Ahmednagar. Mean age of presentation was 68 years (range 31 -89 years).Majority of patients were in the age group of 60 - 69 years i.e 28 (35.90%) patients. Advancing age is the one of the risk factor of fournier’s gangrene.
Results: Triggering factors for FG in our cases series were traumatic laceration of perineum in majority of patients i.e 26 (33.33%) patients. Next factor was repeated needle insertion in 22 (28.20%) patients for removal of hydrocele fluid. Rest of factors were hemorrhoidectomy for prolapsed piles in 5(6.41%) patients, perianal abscess drainage in 2(2.58%) patients, urinary catheterisation in 1(1.28%) patient. Unknown factors was reported in 22(28.20 %) patients. Predisposing risk factors for fournier’s gangrene was diabetes mellitus in 30(38.46%) cases. Next one was advancing age (>50 years) in 21(26.92%) cases. Other factors were steroid use in 15 (19.24%) cases and chronic alcoholic use in 12(15.38%) cases. Most common infecting organism was E.coli in 48 (61.54%) cases. Next organism were Klebsiella in 18(23.08%) patients and Streptococcus in 12(15.38%) cases. Aggressive debidement was performed in all 78(100%) cases. Reconstructive procedures were done in all 78 cases either by secondary suturing in 70(89.75%) cases, skin grafting in 6(7.69%) cases and thigh pouch reconstruction in 2(2.56%) cases. No any mortality was reported.
Conclusion: Fournier’s gangrene is the surgical emergency condition. Fournier’s gangrene is a form of necrotising fasciitis, which causes rapid clinical deterioration with high morbidity and mortality. Aggressive surgical debridement and appropriate antibiotic coverage is the need of hour for high surgical outcomes.
Keywords: Fournier’s gangrene (FG), Necrotising fasciitis, E.coli
