Fournièr’s Gangrene

Fournièr’s gangrene was primarily described by the French dermatologist Jean Alfred Fournier in 1883. Since his publication ,,Gangrene foudroyante de la verge” severe necrotizing infections of the anogenital region are called ,,Fournièr’s Gangrene”. This disease is characterized by a necrotizing fasciitis of the perianal and genital region, caused by an synergistic polymicrobial infection mainly by streptococci and anaerobic bacteria. The infection is typically the consequence of perianal abscess or fistula or the complicating result of previous surgical intervention (f.e. hemorrhoidal excision).

In the literature are several risk factors are mentioned: Diabetes mellitus. Drug and alcohol abuse, radiotherapy, peripheral arterial occlusion, immunosuppression (Table 1).

Typical clinical finding in the first line is severe pain in anal or genital region. This may be accompained by mild cutanous coloring or in sometimes by necrosis of perianal or perigenital region. In more advanced cases patients will present themselves in general septicemia. The diagnosis is based mainly on clinical examination and is fixed by CT-scan.

The key for successful treatment is radical debridement of all infected material and antibiotic therapy systemically administered. The patients should have intensive care surveillance and an planned redebridement is recommended after 24h. In the majority of patients it is absolutely wise to form a covering stoma. Depending on the extent of infection and on the exact anatomical situation the debridement may be supported by vaccuum sealing. For reconstruction of the resulting defect several modilities are described. Only in very rare cases direct wound closure would be possible. The most simple technique would be the application of mesh-graft and in larger defects several flap-procedures are applied with cosmetically good results.

Our own experience is based on 20 patients (12 male) with a median age of 61 years (Table 2).

We had to report an lethality of 35%. This is absolutely within the numbers reported in the literature but it is absolutely interesting in this context to notice that female patients are at an significant higher risk to die.

_PROGNOSIS

Following Literature lethality in Fournièr’s gangrene ranges between 9 % und 40 %. Survival rate is strongly depending on time of diagnosis, start of intervention and kind of surgical therapy. Furthmore it is influenced by age and sex of patients. In some reports FourniŹr’s gangrene after anorectal disease is connected with higher lethality compared to genito-urological origin.

Dr. med. T. H. K. Schiedeck

Department of General and Visceral Surgery Clinic

Ludwigsburg

Germany