Fournier's gangrene: etiology, treatment outcomes and factors affecting mortality in 38 patients

Abstract

Aim: Fournier's gangrene (FG) is a rare, rapidly progressing and life-threatening disease of the genital, perianal and perineal regions. We aimed to evaluate etiological parameters, accompanying diseases, current treatment methods and factors affecting mortality in patients with FG.

Method: The medical records of 38 patients who were operated by the same team with a diagnosis of FG from December 2015 to January 2021 were retrospectively reviewed. Those patients were divided into two groups: survivors (Group 1), and non-survivors (Group 2). Comparisons were made regarding clinical and demographic features; comorbid diseases; leukocyte count at first presentation; etiological factors; treatment outcomes; and mortality rates.

Results: Thirty-eight patients (24 males, 14 females) were evaluated; mean age was 60.2 ± 13.2 years. While 76.3% (n = 29) of these patients recovered with treatment, the total mortality rate was 23.7% (n = 9). The most common cause of the FG and comorbidity were anorectal diseases (n = 22; 57.9%) and type 2 diabetes mellitus (n = 21; 55.3%), respectively. Female gender, septic shock, necrosis, abdominal wall and lumbar region involvement, chronic renal failure, FG development secondary to postoperative complications and ostomy rates were higher in non-survivors. There were no significant differences between the two groups regarding leukocyte count at first presentation, number of debridement, dressing methods, reconstruction methods, and length of hospital stay.

Conclusions: Female gender, presence of septic shock and necrosis on physical examination, involvement of the abdominal wall and lumbar region in addition to the perianal region, chronic renal failure, disease secondary to postoperative complications and the necessity of ostomy play an important role in mortality.