Fourniers gangrene: management experience

Fourniers Gangrene is a fulminating spontaneous necrosis of scrotum. Necrotic process can hit genitalia, peritoneum. Traumatic and infectious etiology. Manifestation is after 2 - 7 days: acute pain in scrotum, necrosis symptoms. Lethality rates up to 30 - 40%, directly proportional to affected area. In case of testis involvement lethality rates raise up to 60 - 90%. Materials and methods. Fourniers Gangrene manifestation, management and long-term results in 13 cases for a period from 1982 to 2009 were analyzed. Decease severity was determined by Fournier Severity Index (FSI), physical examination, laboratory data, ultrasound investigation, x-ray, CT. Results and discussion. All 13 patients were hospitalized due to urgent indications. Mean FSI was 9.1 (0-15). Survived patients mean FSI was 8.6, deceased patients - 12.4. Physical examination showed that in 6 cases only scrotum was involved, in 4 - penis, in 2 - abdomen wall, in 1 - pelvic tissues. All patients underwent surgery immediately after hospitalization. All necrotic tissues excision is demanded. All patients had a course of antibacterial and disintoxication therapy after surgery with renal function monitoring. 2 patients died on a first day after surgery because of infectious-toxic shock. 9 patients underwent plastic surgery after 1 - 2 months. Conclusions. Fourniers Gangrene is a fulminating decease demanding urgent radical surgery in first hours of manifestation. Lethality rates are directly proportional to affected area.