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Category: Volume 05 Issue 08 August 2017
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Title: Factors Affecting Outcome in Patients of Fournier’s Gangrene- A Study

Authors: Dr Chandan Tiwari, Dr Ashutosh Silodia, Dr Dhananjaya Sharma

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i8.133

Abstract

Introduction: Fournier’s gangrene is a rapidly progressive necrotising fasciitis of genitalia, perineum and abdominal wall, that primary involves subcutaneous tissue up to deep fascia. It is a vascular gangrene of infective origin. It is polymicrobial, synergistic infection caused by aerobic and anaerobic organism from colorectal, genitourinary or cutaneous infection. It has got high mortality rate and multiple factors on patient and treatment part affect outcome.

Material and Method: 74 patients with diagnosis of Fournier’s gangrene admitted from September 2014 to September2015 and also which were admitted in last 10yearsin our facility were studied by records. The variables studied were age, haemoglobin, haematocrit, TLC, duration between start of illness and presentation, random blood sugar, comorbidity, serumsodium, potassium, bicarbonate, creatinine, blood urea, pulse and respiratory rate, BP with h/o hypertension, area involved, fever. Blood transfusion, pusculture, antibiotics given. All patients underwent extensive debridement and empirically antibiotics covering gram positive gram negative and anaerobes used subsequently changed after culture sensitivity. Demographic, Disease and Treatment related data is collected and analysed. Variables were compared in survivor and non-survivor group by using statistical methods.

Result & Conclusion: The most commonly affected were 40 and 70 years aged males. Disease affecting in early age was found more aggressive and extensive. Prognosis was found poor in patients presented with age > 45 years, lower mean haemoglobin and haematocrit, mean TLC value>15000/cumm, uncontrolled diabetes, high blood urea and creatinine, electrolyte imbalance. Ecoli was found to be most common organism. Elective use of more than one antibiotic covering whole spectrum of aerobic and anaerobic organism gives good outcome. The overall mortality came out to be 5.4%. Result indicates that aggressive management in these patients improves outcome.

References

  1. Vyas H.G., Kumar A, Bhandari V. et al: Prospective evaluation of risk factors for mortality in patients of Fournier’s gangrene: A single centre experience. Indian journal of urology jul-sep 2013 vol 29, issue 3.
  2. David Kearney: Fournier’s gangrene: Diagnostic and Therapeutic Considera-tions: www.intechopen.com,2011
  3. Feyzullah Ersoz, Sari,S Soykan, Arikan: Factors affecting mortality in Fournier’s gangrene: experience with fifty two patients. Singapore Med J 2012
  4. Adriano Antonio Mehl et al: Management of Fournier's gangrene: experience of a university hospital of Curitiba; Rev. Col. Bras. Cir. vol.37 no.6.Rio de Janeiro.Nov. /Dec. 2010
  5. Erol B, Tunsel A, Hanci V, Tokgoz H ,Yildiz A ,Akduman B et al: Fournier’s gangrene : Overview of prognostic factors and definition of new prognostic parameters. Urology 2010:75:1193-8
  6. Kara E, Muezzinglot, Temeltas G ,Dincer L Kaya Y Sayakara A et al:Evaluation of risk factors and severity of life threatening surgical emergency FOURNIERS GANGRENE [ a report of 15 cases]
  7. Sorenson MD, Krieger JN, Rivara FP, Klien MB, Wessels H: FOURNIERS GANGRENE: Management and mortality predictors in a population based study. J urol 2009:1782:2742-7
  8. Unalp HR, Kamer E,Derici H,Atahan K,Balci U, Demirdovan C etal.: Fourniers Gangrene evaluation of 68 pts and analysis of prognostic variables. j postgraduate med 2008:54:102-5
  9. Corman JM, Moody JA, Aronson WJ .Fournier’s gangrene in modern surgical setting: Improved survival with aggressive mangment. BJU Int 1999:84-85 8
  10. Jeong HJ, Park SC Seoy IY Rim JS: Prognostic factors in Fournier’s gangrene. INT u rol 2005:12:1041-4
  11. Brig Gurjit singh et al: Aggressiveness - the key to a successful outcome in Fournier’s Gangrene
  12. Ruiz-Towarj, Cordoba L, Devensa JM : Prognostic factors in Fournier’s gangrene .Asian.j.surg 2012:35:37-41
  13. Anzai AK: Fournier’s gangrene –a Urologic emergency
  14. Korkut M1, Içöz G, Dayangaç M, Akgün E, Yeniay L, Erdoğan O, Cal C: Outcome analysis in patients with Fournier's gangrene: report of 45 cases;Dis Colon Rectum. 2003 May 46(5):649-52
  15. El Bachir Benjelloun, Tarik S, Nadia Y, Abdelmalek, Ousadden et al: Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality; World Journal of Emergency Surgery 2013, 8:13 doi10.1186/1749-7922-8-13
  16. Tuncel A, Aydin O, Tekdogen U, Nalcacioglu V, Capa Y, Atan A :Fournier’s gangrene : Three years of experience with 20 pts and validity of the FGSI .EUR UROL 2006 :50:838-43
  17. Yenicol CO, Suelogen T, Arslan M, Ayder M :Fourniers Gangrene: Experience with 25 pts and use of Fournier’s gangrene severity index score
  18. Vick R, Carson CC 3rd : FOURNIERS GANGRENE University Clinic north AM 1999:26:841-9
  19. Mehl AA, Nogueira Filho DC, Mantovani LM, Gripa MM. Berger Rkrauss D et al: Management of Fourniers Gangrene; Experience of University Hospital of Curitiva . Rev Col Bras Cir 2010 :37:435-41
  20. Altarac S, Katusin D, Papes D, Razkovik Z, Arsalani N:Fourniers gangrene: Etiology and outcome analysis of 41 patients.Urologyint2012:88:289-93
  21. Fournier JA(1832-1914).Gangrene foudroyantede la verge[overwhelming gangrene]Sem Med 1883 Dis Colon Rectum1988,31,984-8
  22. EKE N, Fournier’s gangrene: A review of 1726 cases .Br j surg 2000 ,87 718-28
  23. Carvalho JP, Hazan A ,Cavalcanti AG, Favorito LA :Relation between the area affected by Fournier’s gangrene and the type of reconstructive surgeryused.A study with 80 patients. Int Braz j urol 2007:8733,510-4
  24. Sallami S, Maalla R, Gammoudi A, Ben Jdidia G, Tarhouni L Horchani A; Four-nier's gangrene: what are the prognostic factors? Our experience with 40 patients: Tunis Med. 2012 Oct;90(10):708-14.
  25. Mallikarjuna MN., Abhishek V, Patil V, and Shivswamy BS; Fournier’s Gangrene: Current Practices: ISRN Surgery Volume 2012, Article ID 942437,doi:10.5402/2012/942437
  26. Jimenez-Pacheo A, Arrablo-Polo MA, Arias-Santiago, Noguerasocunha M, Zulunga .A Fournier’s gangrene ;description of 37 cases and analysis of associated health care costs.
  27. Lujan M, BUDIA S, Di Capua, Broseta E, Jimenez Cruz F, Evaluation of severity score to predict the prognosis of Fournier’s gangrene.BJU int2010.
  28. Kabay S, Yucel M, Yaylak F, Algin MC, Haciglu A. The clinical features of Fournier’s gangrene and predictivity of Fournier’s Gangrene Severity Index its outcome.:Int Urol and Nephrol 2008:40:997-1004
  29. Spirnak JP, Resnik ML, Persky L: FOURNIERS GANGRENE Report of 20 pts .J Urol 1984 131:289-91
  30. Morpurgo E, Galanduik S : FOURNIERS GANGRENE Surgelin North Am 2002:82:1213-24

Corresponding Author

Dr A Silodia

M.S., Associate Professor, Department of Surgery,

N.S.C.B. Medical College and Hospital, Jabalpur, India

Contact: + 91-9826178486, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.