FOURNIER’S GANGRENE

Abstract

Aim. To study the peculiar features of clinicolaboratory radial picture, diagnosis and treatment of Fournier’s gangrene (FG). Materials and methods. The work was based on retrospective analysis of three cases of FG for the period of 2005-2015. In all cases FG patients were admitted to urological clinic with diagnosis of different acute inflammatory diseases of scrotum organs (AIDSO). At the prehospital stage, FG was not recognized. All patients had cormobid immunodeficient background. To diagnose, standard clinicolaboratory studies, roentgenography and ultrasonography of the urogenital organs were carried. Results. Incidence rate of FG was 1 case per every 13 500 AIDSO cases. At the receiving unit, patients underwent clinicoradial examination and AIDSO was excluded in all of them, FG was diagnosed in 2 patients and suspected in 1. When carrying out clinicoradial examination, FG was characterized in all patients by marked systemic inflammatory reaction of the body, progressive course, intensive pains, edema, necrosis and emphysema of external genital organs, and in 1patient - by partial uncovering of testicles and seminiferous tubules. Two patients experienced emergency necrectomy of the scrotum and perineum soft tissues. Two patients recovered, one patient died from septic shock. Conclusions. FG is a rare severe disease requiring emergency surgery. At its early stage it can stimulate AIDSO. Diagnostic criteria of FG are the following: acute onset, septic state, quickly progressing course, local manifestation in the form of severe pains, edema, erythemas, necrosis and emphysema of the external genital organs. Roentgenography and ultrasonography permit to clarify the borders of FG dissemination, to carry out differential diagnosis of FG and other AIDSO, to choose management tactics in time. Treatment of FG is based on emergency operative intervention, antibacterial and antishock therapy. Prognosis of FG is determined by the terms of rendering medical care; delayed medical measures are accompanied by development of infectious-toxic shock and its complications.

Keywords

Fournier’s gangrene / clinicolaboratory and radial picture / diagnosis / management

References

[1] Алиев С. А., Алиев Е. С., Зейналов В. М. Болезнь Фурнье в свете современных представлений. Хирургия 2014; 4: 34-39.

[2] Гринев М. В., Сорока И. В., Гринев К. М. Гангрена Фурнье - клиническая разновидность некротизирующего фасциита. Урология 2007; 6: 69-73.

[3] Привольнев В. В. Гангрена Фурнье. Медицинский вестник МВД 2013; 67(6): 26-32.

[4] Пытель Ю. А., Золотарев И. И. Неотложная урология. М.: Медицина 1985; 320.

[5] Тимербулатов В. М., Хасанов А. Г., Тимербулатов М. В. Гангрена Фурнье. Хирургия 2009; 3: 26-28.

[6] Черепанин А. И., Светлов К. В., Чернов А. Ф., Бармин Е. В. Другой взгляд на «болезнь Фурнье в практике хирурга». Хирургия 2009; 10: 47-50.

[7] Kahramanca S., Kaya O., Ozgehan G. Are neutrophil-lymphocyte ratio and platelet-lymphocyte ratio as effective as Fournier’s gangrene severity index for predicting the number of debridements in Fournier’s gangrene? Ulus. Travma. Acil. Cerr. Derg. 2014; 20 (2): 107-112.

[8] Laor E., Palmer L. S., Tolia B. M. Outcome prediction in patients with Fournier’s gangrene. J. Urol. 1995; 154 (1): 89-92.

[9] Martinschek A., Evers B., Lampl L. Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier’s gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urol. Int. 2012; 89 (2): 173-179.

[10] Misiakos E. P., Bagias G., Patapis P. Current concepts in the management of necrotizing fasciitis. Frontiers in Surgery 2014; 1 (36): 1-10.

[11] Sarvestani A. M., Zamiri M., Sabouri M. Prognostic factors for Fournier’s gangrene; a 10-year experience in Southeastern Iran. Bull. Emerg. Trauma. 2013; 1 (3): 116-122.

[12] Shyam D. C., Rapsang A. G. Fournier’s gangrene. Surgeon 2013; 11 (4): 222-232.

[13] Temiz M. Fournier’s gangrene. Emerg. Med. 2014; 4 (3): 1-2.

RIGHTS & PERMISSIONS

Prokhorov A.V.