Fournier's gangrene in diabetic and renal failure patients

OBJECTIVE: To report our experience in the management of 9 patients with Fournier's gangrene seen in our institute, to identify the most common prognostic variables in our patients, and to evaluate the outcome of aggressive management in patients with Fournier's gangrene.

METHODS: We reviewed the medical records of 9 patients admitted to King Abdul-Aziz University Hospital (KAUH) in Jeddah, Kingdom of Saudi Arabia from November 1999 until November 2002. Their age, sex, clinical presentation, predisposing factors, microbiology testing, management and prognosis were studied.

RESULTS: Nine male patients were diagnosed and treated. The mean age was 68 years, 6 patients (66.6%) were diabetics and one of them had renal insufficiency not requiring dialysis, while 3 patients were on regular hemodialysis. Bacterial culture results revealed a single organism in 44.4%, and more than one organism in 55.6% of the cases. No anaerobes could be cultured, and one patient had Candida albicans. All patients had temporary suprapubic catheter diversion while stool diversion by colostomy was required in only one patient. In 7 patients, aggressive debridement and parental antimicrobial were successful to eradicate the infection, whereas 2 patients (22.2% of the cases) died of uncontrolled sepsis.

CONCLUSION: Fournier's gangrene is a very serious disease, understanding the criteria of early recognition of the disease, referral to the specialist, and aggressive debridement with the use of appropriate antimicrobial therapy will improve the outcome of the patients and decrease the mortality rate.