FOURNIER’S GANGRENE: EXPERIENCE IN A TERTIARY CARE HOSPITAL- A RETROSPECTIVE ANALYSIS OF 288 PATIENTS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 92
Abstract
BACKGROUND Fournier’s gangrene (FG) is a rare but life-threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as longterm alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high. Aim - The purpose of this study is to highlight the aetiopathogenesis, risk factors and outcomes of Fournier’s gangrene. MATERIALS AND METHODS A retrospective descriptive study was conducted on 288 patients of Fournier’s gangrene (ICD-9 CM 608.83) from January 2013 to December 2016 at King George Hospital, Visakhapatnam, Andhra Pradesh, India. All cases who were found to have Fournier’s gangrene at the time of admission were included in the study. RESULTS Among the total 288 patients, 280 were male (97.23%) and 8 were female (2.77%). These cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000). The overall case fatality rate was 22.91% (66). Primary underlying cause leading to Fournier’s gangrene is not identified in 46 (15.97%) patients, which is referred as idiopathic variety. In remaining 242 (84.03%) cases, anorectal disease is leading cause (133, 46.18%) followed by genitourinary diseases (89, 30.90%) and other identifiable aetiology in 20 (6.94%) cases. The risk factors frequently associated with Fournier’s gangrene are diabetes mellitus which is observed in 171 (59.37%), chronic alcoholism in 135 (46.87%), immunosuppression due to advanced malignancy 9 (3.12) and AIDS 5 (1.73%) and other unidentifiable risk factors in 44 (15.27%). Some patients have more than one risk factor like chronic alcoholism and diabetes mellitus 77 (26.73%). CONCLUSION Patients with Fournier’s gangrene are rarely treated at most hospitals because of lack of ICU facilities and unawareness of aetiopathogenesis. It is a very aggressive disease which needs prompt early diagnosis and aggressive management with broad spectrum antibiotics and thorough early debridement. Despite of aggressive management the mortality is still high.
Authors and Affiliations
Satyanarayana Murthy V, Waddi Sudhakar, Naveen Kumar Podili, Ramya Sai Adusumalli
Keywords
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- EP ID EP279210
- DOI 10.14260/jemds/2017/1423
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