Study of the Incidence, Causes and Management of Fournier’s Gangrene in a Tertiary Centre
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
Background-Fournier’s gangrene is an uncommon and nasty condition characterized by a polymicrobial infection of the soft tissues of the perineum, external genitalia and peri-anal region.It is a form of necrotizing fasciitis.There is rapid onset of gangrene leading to exposure of the scrotal contents. Objectives-1 To observe the patient with scrotal edema and inflammation for early detection and management of Fournier’s gangrene.2.To prevent the spreading cellulitis.3.To improve prognosis.4.To decrease mortality and morbidity. Place And Duration-Patients admitted in various surgical wards of Rajendra Institute of Medical Sciences, Ranchi having fournier’s gangrene were included in our study.. The study was conducted during the period from August 2015 to August 2017. Material and methods- Materials for this study consisted of 45 patients of scrotal gangrene admitted to Department of Surgery, Rajendra Institute of Medical Sciences, Ranchi during August 2015 to August 2017.Criteria for diagnosis of cases as Fournier’s gangrene in this study were:A sudden onset of scrotal oedema in an apparently healthy person, progressing rapidly to gangrene.Involvement of part or whole of the scrotum and sometimes the undersurface of penis. Involvement of whole thickness of scrotal skin and subcutaneous tissue in gangrenous process.An associated systemic evidence of rapid and intense toxemia.Absence of any obvious cause of gangrene.A detailed clinical record sheet was prepared for all patients at the time of admission with particular reference to following points: Age, Sex, Case no. ,Religion ,Habitat, Occupation, Socio-economic status, Personal hygiene, Detailed enquiry was made for all patients with regard to: Onset of disease. Severity and duration of associated systemic symptoms, if any. Any predisposing factors. Any associated underlying disorders like – diabetes mellitus, general debilitating condition etc.During history taking, detailed enquiry were made about the presence or absence of systemic symptoms. Systemic symptoms were selected on the basis of various features mentioned in literature. The common features are fever, prostration, pallor, constitutional symptoms of infection like bodyache and malaise, haemodynamic instability and frank septicaemia. Results- All the patients were male between the age group of 25-80 years. Most of patients were in their 5 and 6 decades. Two patients were died in our study. Out of these 36 patients were from rural population and only 9 patients were from urban population making rural to urban population ratio of 4:1. There is a definite relationship between Fournier’s gangrene and socio-economic strata of a particular population(86.4% in a low socio-economic strata). The most common predisposing factor in our study was poor personal hygiene which was seen in 40 out of 45 cases studied. Uncontrolled diabetes was found in 7 cases.20 patients were smokers and 13 were alcoholics. 3 of our patients were asthmatics who were on steroid. Few patients had more than one predisposing factors whereas two had none. Conclusion- 45 male patients in our study were in the range of 25-80 years of age. Majority were in 5th or 6th decades of life. Most of them were from rural background from lower socioeconomic group and had poor personal hygiene. Quite a few of them were still idiopathic in that no definite cause could be found. In those in whom a definite cause could be found some form of trauma was present in most of them. Other conditions which were associated were anorectal abscess drainage and previous operation like Jaboulay’s operation.
Authors and Affiliations
Dr Niranjan Mardi
Keywords
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