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[Perineo-scrotal gangrene: apropos of 31 cases]
A el Mejjad1, A Belmahi, A Choukri
1Service des urgences chirurgicales viscérales, CHU Ibn Rochd, Casablanca, Maroc. amineelmejjad@hotmail.com
Abstract:
Fournier's gangrene is a fascitis of the perineum and of the external genitalia. It is a serious infection with rapid evolution and a severe prognosis. It is also unpredictable towards the necrosis. It concerns a series of 31 cases of the perineal scrotal gangrene supervised in the department of surgical visceral emergency of the Ibn Rochd University hospital of Casablanca between 1992 and 2000. In this investigation, the male predominance is important and the mean age is 49 years. The diagnostic delay is 12 days. The symptomatology was dominated by edema and erythema signs, fever and pain. The skin necrosis was seated in the perineum and the scrotum. A septic shock was noticed in six patients and a condition of deep coma in two other patients. Etiology of gangrene was of coloproctologic origin in 15 cases and of urogenital origin in five patients. The bacteriological parietal swabs was positive in 11 cases. The therapeutic take-in-charge consisted of urgent measures of reanimation for six patients. The likely wide spectrum antibiotic therapy consisting of a triple association (beta lactam antibiotic, nitrite-imidazole compound and aminoglycoside) with a secondary adaptation that was recommended for all patients. All the patient underwent surgical debridement of the necrotic tissue with incisions and drainage of the involved areas of the of all the operated-on patients, 26 had colostomy, five among them had both colostomy and cystostomy. The overall evolution was favorable except in eight cases of death. In all, the authors insist on the positive diagnosis as well as the early take-in-charge of the disease to avoid complications of local or general order and recommended the preventive treatment with the precocious treatment of the causing infection.
Insights
Fournier's gangrene, a severe necrotizing fasciitis, requires prompt diagnosis and aggressive treatment including surgery and broad-spectrum antibiotics. Early intervention significantly improves patient outcomes and reduces mortality rates.
Area of Science:
- Urology
- Infectious Diseases
- Surgical Emergency
Background:
- Fournier's gangrene is a rapidly progressing, life-threatening infection affecting the perineum and genitalia.
- Necrosis and severe prognosis are characteristic, often leading to systemic complications.
Purpose of the Study:
- To analyze the clinical features, etiology, and outcomes of Fournier's gangrene.
- To evaluate the effectiveness of early diagnosis and management strategies.
Main Methods:
- Retrospective review of 31 patients with perineal scrotal gangrene treated between 1992 and 2000.
- Analysis of diagnostic delay, symptomatology, etiology, treatment protocols, and patient outcomes.
Main Results:
- Male predominance (mean age 49 years) with a 12-day diagnostic delay.
- Common symptoms included edema, erythema, fever, and pain; coloproctologic (15 cases) and urogenital (5 cases) origins were frequent.
- High rates of surgical debridement, colostomy (26 patients), and broad-spectrum antibiotic therapy were employed, with an overall mortality of 8/31.
Conclusions:
- Early diagnosis and prompt, aggressive management, including surgical debridement and broad-spectrum antibiotics, are crucial for improving survival.
- Preventive treatment of underlying infections is recommended to reduce the incidence of Fournier's gangrene.