Complicated Fournier's gangrene in a Third Level Hospital

Let's talk about four cases

Abstract

It is a potentially fatal, sudden, progressive infectious process, of multibacterial etiology, but of low virulence (E.coli, Klebsiella, Proteus, Staphylococci, clostridium, bacteroides, fusobacterium, etc.) that causes affection of subcutaneous cellular tissue, fasciae and skin ( necrotizing fasciitis) of the perineal region and genitalia. It is rare but its condition increases in immunocompromised patients, diabetes (decreased phagocytosis and chimiotaxis), neoplasms, alcoholism, kidney failure, malnutrition, obesity, chronic corticosteroid therapy, where bacteria become very aggressive and destructive of tissues, reaching a causes systemic symptoms such as septic shock that compromises life.

The origin is usually a perianal abscess, anal fistulas, rectal injuries, hemorrhoids, or ligatures of hemorrhoids, pressure ulcers, episiotomy in women, bartholinitis, etc.

The present work included 4 cases for analysis. The average age of the patients was 56 years old (range 33-83 years), 4 patients had some personal pathological history. Among the risk factors presented was diabetes mellitus in all 4 patients; of these 1 with anal cancer undergoing chemotherapy, 1 with morbid obesity, hypertension with restrictive respiratory insufficiency, 1 with incarcerated inguino-scrotal hernia plus chronic renal failure and double amputation of lower extremities (inability to walk) and 1 with traumatic urethral rupture due to catheterization plus chronic renal failure and CVD with inability to walk.