OBSERVATIONAL STUDY OF FOURNIER’S GANGRENE IN RURAL HOSPITAL

Dr. Amit B. Aiwale; Dr. Sudhir Deshmukh; Dr.Rupesh Thakare; Dr. Santosh Angarwar

Volume : V, Issue : IV, April - 2016

OBSERVATIONAL STUDY OF FOURNIER’S GANGRENE IN RURAL HOSPITAL

Dr. Amit B. Aiwale, Dr. Sudhir Deshmukh, Dr. Rupesh Thakare, Dr. Santosh Angarwar

Abstract :

Background: Fournier�s gangrene is an infective necrotizing fasciitis of scrotum & perineum associated with high morbidity and mortality. Predisposing factors include various states of immunosuppression, such as diabetes mellitus, chronic alcoholism, acquired immune deficiency syndrome, and malnutrition. Objective: To study different clinical and prognostic parameters in relation to presentation and management of Fournier�s gangrene in a rural set up. Methods: Retrospective observational study .Detailed record of each patient�s data was obtained from institution�s record section and case papers. Written informed consent of procedures was checked from each patient for necessary surgical procedure Results: In this study we found boil over genital region as cause in 5 patients, trauma in 2, periurethral conditions such as periurethral abscess and long standing indwelling catheter in 5 patients, perianal conditions in 8 patients. we found associated predisposing comorbid conditions such as DM in 11 patients, alcoholism in 10 patients, HIV in 1 and other like COPD , HTN, Steroid abuse etc. were 7 patients. study we had 6 patients with scrotal involvement, 8 patients with both scrotum & inguinal region,4 patients with Scrotum & perineum involvement. While 5 patients had Scrotum, perineum, inguinal & abdomen involved. 3 patients had scrotum, perineum & inguinal involvement. Of all 28 patients, 11 patients had polymicrobial involvement while Staphylococci & Klebsiella were found in 4 and 5 patients respectively. 3 patients had Streptococcal infection, 1 had clostridiumand 3 had E. Coliinfection. Among all, 8 patients required 1 deidement, 11 patients required 2 deidement�s, 8 patients required 3 deidement�s& only 1 patient required 4 times deidement. Of 28 patients 7 were managed with secondary suturing and 6 required testicular reposition with creation of pouch in thigh and inguinal region and 14 patients required critical care management in surgical ICU. Average Total hospital stay for each patient was about 31.5 days ranging from 21 to 63 days. Out of 28 patients one patient died after 2 days of admission. Conclusion: The Fournier�s gangrene is sever surgical emergency which presents in adult age group more common in males. Surgical deidement, IV antibiotic and secondary reconstructive procedure involves the treatment strategy