[Perineal gangrene. Analysis of 24 cases]

Fournier's syndrome, characterised by anaerobic necrotising cellulitis of the soft tissues situated below the diaphragm, is a serous disease with an unpredictable course. From 1978 to 1991, we treated 24 men with a mean age of 57 years (27 to 90 years). Following the diagnosis of this disease, rigorous treatment was instituted immediately, consisting of a triple antibiotic combination, repeated surgical exposure, debridement and drainage with a frequent, almost systematic indication for faecal diversion (n = 16), hyperbaric oxygen therapy and classical intensive care measures. The mean interval between the first clinical signs and the diagnosis was 7.4 days. The lesions were limited to the perineum in 11 cases and extended to the abdomen, thighs and/or loins in 13 cases. The microorganisms responsible for the infection were identified in 19 cases and blood cultures were positive in 5 cases. This infection was of coloproctological origin in 12 cases, urogenital origin in 4 cases and postoperative in 2 cases, while no aetiology could be identified in 6 patients. There were 6 deaths and 18 cures without sequelae. 1. The prognosis of this disease is better in younger subjects (under the age of 60 years) with a localised clinical form, with no deterioration in the general status, sterile blood cultures and treated by a diversion colostomy. 2. A detailed aetiological work-up must be performed, looking for local or regional infection, cancer, haematological malignancy or arterial disease.