Abstract
Fournier's gangrene is a relatively rare, mixed aerobic and anaerobic soft tissue infection in the perineoscrotal area. Although it is convenient to give it a separate name, it is really either necrotizing fasciitis or non-clostridial myonecrosis of the scrotal and perineal areas. The condition frequently develops from perianal diseases, including perianal abscess, anal fistulas, inflamed haemorrhoids and indwelling urethral catheter. In patients with Fournier's gangrene morbidity is extreme and mortality high. This article is based on a retrospective study of 15 cases of Fournier's gangrene, 13 in male and 2 in female patients. A combination of surgery and antibiotics was used to treat 9 patients. The last 6 cases were treated with a combination of surgery, antibiotics and hyperbaric oxygen. In 13 cases, the diagnosis was made on the basis of the fulminating progression of the infection to a scrotal gangrene, identification of multiple underlying pathogenic organisms and toxaemia. In the 2 female patients, a similar infection developed in the labia majora and perineum and extended to the buttocks and the anterior abdominal wall.
Zusammenfassung
Fournier-Gangrän ist eine seltene, gemischt aerob-anaerob nekrotisierende Fasziitis oder nonklostridiale Myonekrosis des perineoskrotalen Gewebes und geht meistens von perianalen Erkrankungen aus, wie z.B. perianale Abszesse, anale Fisteln, infizierte Hämorroiden oder eingeführten Harnrbhrenkathetern. Die Patienten mit Fournier-Gangran haben eine hohe Morbiditäts-und Mortalitätsrate. In dieser Studie haben wir 15 Patienten im Zeitraum Januar 1980 bis April 1993 retrospektiv untersucht. Davon waren13 Männer und 2 Frauen. Die Diagnosen wurden durch fulminanten Fortschritt der Gangrän zu den extraskrotalen (extralabialen) Geweben, durch Identifikation multipler pathologischer Organismen und durch klinische Befunde der systemischen Toxizität gestellt. Neun Patienten wurden chirurgisch und medikamentös behandelt, bei den übrigen 6 Patienten wurde zusätzlich eine hyperbare Oxygenation durchgeführt. Dadurch wurde die Letalität von 40% (6/15) auf 16% (1/6) gesenkt.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Literatur
Bahlman JCM, Fourie IJVH, Arndi ICH (1983) Fournier's gangrene: Necrotising fasciitis of the male genitalia. Br J Urol 55:85
Bakker DJ (1987) Pure and mixed aerobic and anaerobic soft tissue infections: The role of surgery, hyperbaric oxygen and antibiotics. Proceedings of the Eight International Congress on Hyperbaric Medicine August 20–22, 1984. Long Beach, Ca, pp 112–119
Begley MG, Shawker TH, Robertson CN, Wei JP, Lotze MT (1988) Fournier gangrene: Diagnosis with scrotal US. Radiology 169:387–389
Bode WE, Ramos R, Page CR (1982) Invasive necrotizing infection secondary to anorectal abscess. Dis Colon Rect 25: 416–429
Cunningham BT, Nivatvongs Shons AR (1979) Fournier's syndrome following anorectal examination and mucosal biopsy. Dis Colon Rectum 22:51
Eltorai IH, Hunt GB, Strauss MB, Montray R, Jule GL (1986) The role of hyperbaric oxygen in the management of Fournier's gangrene. Int Surg 71:53–58
Enriquez JM, Movera S, Seresa H, Morales V, Plares A, Virale E (1987) Fournier syndrome of urogenital and anorectal origin: a retrospective comparative study. Dis Colon Rectum 30:33–37
Flanigan RC, Kursh ED, McDovgal WS, Pensky L (1978) Synergistic gangrene of the scrotum and penis secondary to colorectal disease. J Urol 119:369
Fournier JA (1988) Etude clinique de la gangrene four drayante de la verge. Sem Med (Paris) 4:69
Gaeta M, Volta S, Minutali A, Bartiroma G, Pandolfa I (1991) Fournier gangrene caused by a perforated retroperitoneal appendix CT demonstration. Am J Roentgenol 156/2:341–342
Him M, Niinikoski J (1990) Perineal necrotizing fasciitis treated with surgery, antibiotics and hyperbaric oxygen. EUBS 1990 Proceedings. Conference Papers of the XVIth Annual Meeting of European Undersea Biomedical Society. Joint meeting on divine and hyperbaric medicine. Amsterdam, The Netherlands, Aug. 11–18, 1990, pp 219–225
Jones RB, Hirschman JV, Brown GS (1979) Forunier's syndrome: Necrotizing subcutaneous infection of the male genitalia. J Urol 122:279–282
Kobberman T, Strausbaugh L, Poole AG, Llorens AS (1983) Postpartum perineal necrotizing fasciitis. Mo Med 80:746–750
Mader JT (1981) Phagocytic killing and hyperbaric oxygen: antibacterial mechanisms. HBO Rev 2:37–49
McDonald DF, Hulet WH, Cowan JW (1975) Scrotal gangrene treated with oxygene under high pressure. J Urol 113:364
Riegel-Nielsen P, Hesselfeldt-Nielsen, Borg-Jensen E, Jacopsen E (1984) Fournier's gangrene: five patients treated with hyperbaric oxygene. J Urol 132:918–920
Silva-Villasenor JA, Velazquez Mactas RE, Suarez J (1991) Fournier's gangrene in a newborn. Gangre de Fournier en un neonato. Bol Med Hosp Infant Mex Jam 37/1:48–56
Sumers WJ, Love FC (1986) Localized gangrene of the scrotum and penis: A complication of heroin injection into the femoral vessels. J Urol 136:111
Van der Meer JB, Van der Wal T, Bas WH, Mulder W (1991) Fournier's gangrene: The human counterpart of the local Schwartzman phenomenon. Arch Dermatol 126
Vujnovic D (1980) Periurethral phlegmone, Fournier's gangrene and hyperbaric oxygene. Hyperbaric Medicine Proceedings. 2nd Swiss an hyperbaric medicine. 2nd European conference on hyperbaric medicine 1980, pp 217–219
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Ersan, Y., Özgültekin, R., Çetinkale, O. et al. Fournier-gangrän. Langenbecks Arch Chir 380, 139–143 (1995). https://doi.org/10.1007/BF00207718
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00207718