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[Perineo-scrotal gangrene. Analysis of 49 cases]
A el Moussaoui1, R Aboutaieb, A Joual
1Service d'Urologie, CHU IBN ROCHD, Casablanca, Maroc.
Abstract:
Perineo-scrotal gangrene is a necrotizing infection of the tissues of the perineum and scrotum. It accounts for 0.6% of our hospitalizations. The commonest etiology is urologic (86% of our cases). A proctologic origin was found in 6%, while the condition appeared to be primary in 8%. Concomitant diseases were found in 37% with diabetes the commonest. The diagnosis is clinically evident. The majority of patients are seen late (5 to 10 days) and the necrotizing process spreads rapidly. This is a multidisciplinary emergency, requiring intensive care, antibiotics, surgical excision of all necrotic tissues and possible urinary and/or fecal diversion. Extensive skin loss requires surgical cutaneous reconstruction procedures. The prognosis is severe, with a 12% mortality rate in our series.
Insights
Perineo-scrotal gangrene, a severe necrotizing infection, often stems from urologic issues and requires urgent multidisciplinary care. Early diagnosis and intervention are crucial for improving patient outcomes and reducing the significant mortality rate.
Area of Science:
- Urology
- Infectious Diseases
- Surgical Pathology
Context:
- Perineo-scrotal gangrene represents a rare but severe necrotizing infection.
- This condition accounts for 0.6% of hospitalizations, with urologic origins in 86% of cases.
- Concomitant diseases, particularly diabetes, are present in 37% of patients.
Purpose:
- To analyze the etiology, clinical presentation, management, and outcomes of perineo-scrotal gangrene.
- To highlight the critical need for prompt multidisciplinary intervention in managing this emergency.
- To assess the mortality rate associated with this severe infection.
Summary:
- Diagnosis is primarily clinical, with patients often presenting late (5-10 days).
- Management involves intensive care, antibiotics, surgical debridement of necrotic tissue, and potential urinary/fecal diversion.
- Extensive tissue loss necessitates reconstructive surgery.
Impact:
- The condition has a severe prognosis, with a reported mortality rate of 12% in the series.
- Highlights the importance of timely and aggressive treatment strategies.
- Emphasizes the need for awareness among healthcare professionals regarding risk factors and presentation.