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Open Access Highly Accessed Research article

Fournier’s gangrene: our experience with 50 patients and analysis of factors affecting mortality

El Bachir Benjelloun1*, Tarik Souiki1, Nadia Yakla1, Abdelmalek Ousadden1, Khalid Mazaz1, Abdellatif Louchi1, Nabil Kanjaa2 and Khalid Ait Taleb1

Author Affiliations

1 Department of surgery, University hospital Hassan II, Fez, Morocco

2 Department of Anesthesiology and Intensive Care, University hospital Hassan II, Fez, Morocco

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World Journal of Emergency Surgery 2013, 8:13  doi:10.1186/1749-7922-8-13

Published: 1 April 2013

Abstract

Introduction

Fournier’s gangrene is a rare, rapidly progressive, necrotizing fasciitis of the external genitalia and perineum. Case series have shown a mortality rate of 20% to 40% with an incidence of as high as 88% in some reports. In this study we aimed to share our experience in the management of Fournier’s gangrene and to identify risk factors that affect mortality.

Methods

The medical records of 50 patients with Fournier’s gangrene who presented at the University Hospital Hassan II of Fez from January 2003 to December 2009 were reviewed retrospectively to analyze the outcome and identify the risk factors and prognostic indicators of mortality.

Results

Ten males and five females were enrolled in the study. The mean age was 54 years (range 23–81). The most common predisposing factor was diabetes mellitus (34%). E. coli was the most frequent bacterial organisms cultured. All patients were treated with a common approach of resuscitation, broad-spectrum antibiotics, and wide surgical excision. The mortality rate was 24%. The advanced age, renal failure on admission, extension of infection to the abdominal wall, occurrence of septic shock and need for postoperative mechanical ventilation are the main prognostic factors of mortality. In multivariate analysis, none of these variables is an independent predictor of mortality.

Conclusions

Fournier’s gangrene is still a very severe disease with high mortality rates. Early recognition of infection associated with invasive and aggressive treatment is essential for attempting to reduce these prognostic indices.

Keywords:
Fournier’s gangrene; Mortality; Outcome analysis