A CLINICOPATHOLOGICAL STUDY OF FOURNIER S GANGRENE AND ITS MANAGEMENT: EARLY DEBRIDEMENT BETTER PROGNOSIS.

Corresponding Author:
Dr. Brijesh Singh,
MIG–18, Housing Board Colony,
Bodabag, Rewa–486001,
Madhya Pradesh.
E-mail: drbrijeshsinghrewa@gmail.com

ABSTRACT

BACKGROUND 

Fournier’s Gangrene (FG) is a rare, but life-threatening disease. FG has been shown to have a predilection for patients with diabetes as well as long-term alcohol misuse. 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.

AIM

To assess the predisposing factors various clinical presentations, common causative organisms and culture sensitivity, histopathological findings and treatment of Fournier’s gangrene.

STUDY DESIGN

A prospective study conducted over a period from disclosure, Dec 2014 to Nov 2015 in a tertiary care institute.

RESULTS

In our study of 50 cases, all the patients were males. Incidence of Fournier’s gangrene in general surgical admission is 0.69%. The mean age of presentation was 50.14 years with age range of 20 to 85 years and most of the patients were in the age group 36-45 years (38%). In 44 patients (88%), there was a history of associated co-morbid condition; 36 cases (72%) of diabetes mellitus, 34 cases (64%) poor personal hygiene, 31 cases (62%) low socioeconomic status, 28 cases (56%) chronic alcoholisms, 17 cases (34%) hypertension, 3 cases (6%) HIV infection and 1 case (2%) was of malignancy, while in 6 patients (12%) we could not identify any underlying co-morbid condition. Type 1 was the most common type of Fournier gangrene, in which the E. Coli was the most common organism isolated (64%). Surgical debridement was done in all the cases after the initial fluid resuscitation and empirical broad spectrum antibiotic treatment. Mortality was low (4%) in our study because of early and aggressive management of disease.

CONCLUSION

Fournier’s gangrene is more common in middle aged males. Diabetes mellitus is the most common co-morbid condition associated with necrotizing fasciitis. The perineum is commonly affected. The presence of multiple co-morbid conditions reduces the survival. Early diagnosis and aggressive surgical debridement reduces mortality.

KEYWORDS

Fournier’s Gangrene, Early Debridement, Outcome.