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[Perineal gangrene: report of 30 cases observed at Abidjan]
K Kouadio1, Y J Kouame, K L Bi
1Service de Chirurgie Générale et Digestive 1, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.
Abstract:
Perineal gangrene may be classified as primary, e.g. Fournier's gangrene of the external genitals, or secondary due to locoregional injury. Perineal gangrene is still a topic of interest in tropical zones where mortality remains high despite current therapeutic modalities. The purpose of this retrospective study was to analyze etiologic, bacteriologic, and therapeutic data in 30 cases observed over a one-year period in a surgical setting in the Ivory Coast. There were 26 men and 4 women with a mean age of 43 years. All were treated by extensive removal of necrotic tissue in association with antimicrobial therapy for the likeliest agent and appropriate supportive measures. Colostomy was performed in 6 cases and drainage of the urinary tract was required in 11 cases. Anti-tetanus treatment was administered in all cases. Thirteen patients were HIV-positive, five were diabetic, and two presented chronic renal insufficiency. Perineal gangrene was classified as secondary in 17 cases and primary (Fournier's gangrene) in 13 cases. Bacteriologic study of puss and tissue specimens collected from necrotic areas demonstrated a mixed population of microbial organisms predominated by streptococcus A (n = 19) and Escherichia coli (n = 13). Positive diagnostic results were obtained in 5 of 20 hemocultures and in 8 of 11 cystobacteriologic tests. Eight patients died and nine presented complications including necrosis of the testicles, atrophy of the testicles, shock, and coma. Healing was obtained without skin grafting in 22 survival cases but 5 of them required secondary suturing. The mean duration of hospitalization was 45 days. In our experience, perineal gangrene led to severe consequences despite adequate management especially in HIV-infected patients. The treatment of choice is still extensive emergency surgical removal (repeated, if necessary) of necrotic tissue in association with adequate supportive measures and wide spectrum antimicrobial therapy.
Insights
Perineal gangrene, particularly Fournier's gangrene, remains a severe condition in tropical regions. Early surgical debridement and antimicrobial therapy are crucial for managing this condition, especially in immunocompromised patients.
Area of Science:
- Medical Microbiology
- Surgical Pathology
- Infectious Diseases
Context:
- Perineal gangrene, including Fournier's gangrene, presents a significant challenge in tropical zones with high mortality rates.
- This retrospective study analyzes 30 cases managed in a surgical setting in Ivory Coast over one year.
Purpose:
- To analyze the etiologic, bacteriologic, and therapeutic data of perineal gangrene cases.
- To evaluate treatment outcomes and identify factors influencing mortality and complications.
Summary:
- The study included 30 patients (26 men, 4 women; mean age 43) with primary (13) or secondary (17) perineal gangrene.
- Treatment involved extensive debridement, antimicrobial therapy (predominantly targeting Streptococcus A and Escherichia coli), supportive care, and in some cases, colostomy or urinary tract drainage.
- Comorbidities included HIV (13), diabetes (5), and chronic renal insufficiency (2). Eight patients died, and complications occurred in nine survivors.
Impact:
- Perineal gangrene leads to severe consequences, particularly in HIV-infected individuals, despite aggressive management.
- The findings underscore the importance of emergency surgical debridement, broad-spectrum antibiotics, and supportive care.
- Optimal management requires prompt surgical intervention and tailored antimicrobial strategies to reduce mortality and morbidity.