Fournier’s Gangrene: Report of 22 Cases at Dammam Medical Complex

Objectives: The objectives of this retrospective review of a case series of Fournier's gangrene (FG) treated at Dammam Medical Complex from April 2008 to April 2015 were to evaluate the risk factors, etiology, microbiological characteristics, hospital management, and outcome for FG patients. Materials & Methods: The author retrospectively reviewed the clinical records of 22 patients diagnosed with FG. Data collected include age, sex, etiology, associated diseases, bacteriology, treatment modalities, and outcome. Results: Of the 22 patients, 18 were men (82%) and four were women (18%). The average age was 54.7 years (range: 38–78 years). Predisposing disorders were identified in 86% of patients, and 82% of them were diabetics. The etiology identified in patients included urogenital infections (36%) and anorectal sepsis (36%). Cutaneous and subcutaneous infections were identified in 23% of patients. One patient (5%) had perforated acute appendicitis, which developed into necrotizing fasciitis of the scrotum, right flank, and anterior abdominal wall. More than one bacterium was found in the tissue culture of 68% of patients, the most frequent being Escherichia coli. All patients were treated with a broad spectrum of antibiotics and urgent, aggressive surgical debridement. Wound healing by secondary intention occurred in 69% of surviving patients. Tissue reconstruction using local flaps or skin grafts was required in five patients. The overall mortality rate was 27% and was found to be higher in elderly patients. Conclusion: FG is a rare and still potentially fatal infectious necrotizing fasciitis of the perineum and abdominal wall along the scrotum and penis in men and vulva in women. Patients at risk include the elderly and diabetics. An etiology can be identified in most cases. Early recognition and intervention with aggressive debridement, combined with antibiotics therapy, are essential for a successful outcome.