Fournier's gangrene by perianal abscess

To describe and analyze the cases of Fournier's Gangrene caused by perianal abscess treated in a tertiary hospital in western Paraná, correlating possible factors that influence mortality, with emphasis on late diagnosis and therapy.

Methods:

A retrospective and descriptive case series was carried out based on the analysis of medical records of patients with Fournier's Gangrene due to perianal abscess from January 2012 to December 2017.

Results:

Thirty-one patients with Fournier's Gangrene due to perianal abscess were treated in the period: 26 men and 5 women. Mean age was 53.51 ± 14.5 years. The most prevalent comorbidity in this group was type 2 diabetes mellitus, showing a strong correlation with mortality. The mean time from disease progression, from the initial symptom to the admission at the service, was 9.6 ± 6.81 days. All patients were submitted to antibiotic therapy and surgical treatment, with a mean of 3.25 ± 2.89 procedures/patient. Seven (22.58%) patients died and all of them showed signs of sepsis on admission; only 2 patients with sepsis did not die.

Conclusion:

The presence of sepsis on admission and type 2 diabetes mellitus were strongly correlated with mortality.

Keywords:
Fournier's gangrene; Necrotizing fasciitis; Abscess; Colorectal surgery; Debridement

Gender	Age (years)	Comorbidities	CCI	Pre-diagnosis evolution (days)	Hospital length of stay (days)	Total procedures performed	Presence of sepsis on admission	Death
M	50	DM2	3	7	11	3	-	-
M	47	Absent	0	6	8	1	-	-
M	23	Paraplegia and CKD	4	4	41	14	-	-
F	77	DM2 and SAH	4	10	13	6	YES	YES
M	74	Smoking	4	14	20	1	-	-
M	51	DM2	2	14	14	2	-	-
M	62	SAH, cardiopathy and smoking	4	15	27	4	-	-
M	68		2	7	15	3	-	-
M	53	SAH, DM2, dyslipidemia and cardiopathy	4	6	35	7	YES	YES
F	61	DM2 and SAH	4	30	10	1	-	-
M	47	Smoking	1	15	31	4	-	-
M	69	DM2 and SAH	3	5	17	3	-	-
M	73	SAH	3	15	20	1	-	-
M	40		0	7	9	2	-	-
F	51	DM2, SAH, smoking and obesity	4	10	26	5	YES	YES
M	78	SAH and smoking	4	30	17	1	-	-
M	63	DM2 and smoking	5	7	55	5	YES	YES
F	54	DM2	2	4	24	4	-	-
M	73	DM2 and CKD	7	2	2	1	YES	YES
M	35	Smoking	1	5	3	1	-	-
M	38	Smoking	1	15	5	1	YES	-
F	31		0	16	8	1	-	-
M	41		0	7	10	2	-	-
M	46		0	8	2	1	YES	YES
M	48	DM2 and SAH	1	9	16	4	-	-
M	58	SAH and chronic liver disease	4	5	12	3	-	-
M	56	DM2 and obesity	2	1	42	6	YES	-
M	31	Smoking	1	7	3	1	-	-
M	44	DM2 and cardiopathy	2	5	2	1	-	-
M	50	Obesity	1	7	129	9	-	-
M	67	DM2 and SAH	4	7	29	3	YES	YES

Variables	Results
Male	26 (83.87%)
Female	5 (16.13%)
Age	53.51 ± 14.56 years
Type 2 Diabetes Mellitus	14 (45.16%)
Systemic Arterial Hypertension	11 (35.48%)
Smoking	9 (29.03%)
Alcohol use	6 (19.35%)
Pre-diagnosis evolution	9.6 ± 6.81 days
Sepsis on admission	9 (29%)

Type of surgical procedure	Number of procedures performed
Debridement	85
Colostomy	5
Anorectal abscess drainage	3
Cystostomy	2
Flaps	2
Reconstructions	1
Other procedures^a a Lower limb fasciotomy, scrotal abscess drainage and exploratory laparotomy.	3
Total	101

	Mortality		p
	Yes (total 7)	No (total 24)	p
Pre-diagnosis evolution ≥7 days	5	16	0.34823
Presence of sepsis on admission	7	2	0.00001
Patient with Type 2 Diabetes Mellitus	6	8	0.01941
Hospital length of stay ≥20 days	4	8	0.18240

Sociedade Brasileira de Coloproctologia Av. Marechal Câmara, 160/916, 20020-080 Rio de Janeiro/RJ Brasil, Tel.: (55 21) 2240-8927, Fax: (55 21) 2220-5803 - Rio de Janeiro - RJ - Brazil
E-mail: sbcp@sbcp.org.br

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[1] ⁎Corresponding author. natielesantossouza@outlook.com