Abstract
Objective
Fournier’s gangrene is a necrotizing fasciitis that affects the perineal, genital, or perianal regions. The objective of this study was to highlight this uncommon condition with a particular focus on the disease course in females.
Materials and methods
From 1996 to 2008, we prospectively collected data from 38 patients with Fournier’s gangrene (12 women, 26 men) and retrospectively analyzed relevant parameters.
Results
The mean age was 60.9 ± 11.3 years for females (group I) and 56.2 ± 11.7 years for males (group II). In both groups, the main predisposing factors were diabetes mellitus and obesity (body mass index of 30 or higher). Twelve men (46.2%), but no women, had chronic alcoholism. The most commonly isolated agents were Escherichia coli (n = 22), streptococcal species (n = 18), Pseudomonas aeruginosa (n = 9), and Staphylococcus aureus (n = 7). Mortality was significantly higher among females (50%) than males (7.7%; p = 0.011). Peritonitis was present in seven group I patients (58.3%) and in two group II patients (7.7%). The retroperitoneum was involved in seven female patients (58.3%) and four male patients (15.4%).
Conclusion
The female gender is a risk factor for mortality in patients with Fournier’s gangrene and is associated with a higher incidence of inflammation of the retroperitoneal space and abdominal cavity. Differences in male and female genital anatomy may be the reason for the rapid spread of infection to the retroperitoneum and the fatal outcome in women. Fournier’s gangrene as a high-risk disease in females should attract exceeding attention.
Similar content being viewed by others
References
Fournier JA (1883) Gangrene foudroyante de la verge. Medecin Practique 4:589–597
Fournier JA (1884) Etude clinique de la gangrene foudroyante de la verge. Semaine Med 4:69
Meleney FL (1924) Hemolytic streptococcus gangrene. Arch Surg 9:317–364
Smith GL, Bunker CB, Dinneen MD (1998) Fournier’s gangrene. Br J Urol 81:347–355
Eke N (2000) Fournier’s gangrene: a review of 1726 cases. Br J Surg 87:718–728 doi:10.1046/j.1365-2168.2000.01497.x
Fisher JR, Conway MJ, Takeshita RT, Sandoval MR (1979) Necrotizing fasciitis. Importance of roentgenographic studies for soft tissue gas. JAMA 241:803–806 doi:10.1001/jama.241.8.803
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20(6):864–874
Hejase MJ, Simonin JE, Bihrle R, Coogan CL (1996) Genital Fournier’s gangrene: experience with 38 patients. Urology 47:734–739 doi:10.1016/S0090-4295(96)80017-3
Stephens BJ, Lathrop JC, Rice WT, Gruenberg JC (1993) Fournier’s gangrene: historic (1764–1978) versus contemporary (1979–1988) differences in etiology and clinical importance. Am Surg 59:149–154
Baskin LS, Carroll PR, Cattolica EV, McAninch JW (1990) Necrotizing soft tissue infections of the perineum and genitalia. Bacteriology, treatment and risk assessment. Br J Urol 65:524–529
Hollabaugh RS Jr, Dmochowski RR, Hickerson WL, Cox CE (1998) Fournier’s gangrene: therapeutic impact of hyperbaric oxygen. Plast Reconstr Surg 101:94–100 doi:10.1097/00006534-199801000-00016
Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB (2002) Management of Fournier’s gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg 68:709–713
Gürdal M, Yücebas E, Tekin A, Beysel M, Aslan R, Sengör F (2003) Predisposing factors and treatment outcome in Fournier’s gangrene. Urol Int 70:286–290 doi:10.1159/000070137
Ahrenholz D (1988) Necrotizing soft tissue infections. Surg Clin North Am 68:199–214
Roberts H, Hester L (1972) Progressive synergistic bacterial gangrene arising from abscesses of the vulva and Bartholin’s gland duct. Am J Obstet Gynecol 114:285–291
Scott SD, Dawes RFH, Tate JJT, Royle GT, Karran SJ (1988) The practical management of Fournier’s gangrene. Ann R Coll Surg Engl 70:16–20
Vaz I (2006) Fournier’s gangrene. Trop Doct 36:203–204 doi:10.1258/004947506778604724
Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcyn O (2006) Fournier’s gangrene: report of thirty-three cases and a review of the literature. Int J Urol 13:960–967 doi:10.1111/j.1442-2042.2006.01448.x
Mindrup SR, Kealey GP, Fallon B (2005) Hyperbaric oxygen for the treatment of Fournier’s gangrene. J Urol 173:1975–1977 doi:10.1097/01.ju.0000158129.56571.05
Basoglu M, Gül O, Yildirgan I, Balik AA, Oezbey I, Oeren D (1997) Fournier’s gangrene: review of fifteen cases. Am Surg 63:1019–1021
Ferreira PD, Reis JC, Amarante JM, Silva AC, Pinho CJ, Oliveira IC, da Silva PN (2006) Fournier’s gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg 119:175–184 doi:10.1097/01.prs.0000244925.80290.57
Attah CA (1992) New approach in the management of Fournier’s gangrene. Br J Urol 70:78–80
Barkel DC, Villalba MR (1986) A reappraisal of surgical management in necrotizing perineal infections. Am Surg 52:395–397
Saijo S, Kuramoto Y, Yoshinari M, Tagami H (1990) Extremely extended Fournier’s gangrene. Dermatologica 181:228–232
Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I (2006) Fournier’s gangrene: risk factors and strategies for management. World J Surg 30:1750–1754 doi:10.1007/s00268-005-0777-3
Norton KS, Johnson LW, Perry T, Perry KH, Sehon JK, Zibari GB (2002) Management of Fournier’s gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment. Am Surg 68:709–713
Clarke-Pearson DL, Olt G, Rodriguez G, Boente M (1996) Preoperative evaluation and postoperative management.. In: Berek JS, Adashi Y, Hillard PA (eds) Novak’s gynaecology, . 12th edn. Williams and Wilkins, Baltimore, Maryland, pp 543–617
Benizri E, Fabiani P, Migliori G et al (1996) Gangrene of the perineum. Urology 47:935ff
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Czymek, R., Frank, P., Limmer, S. et al. Fournier’s gangrene: is the female gender a risk factor?. Langenbecks Arch Surg 395, 173–180 (2010). https://doi.org/10.1007/s00423-008-0461-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-008-0461-9