Gangrena de Fournier: análisis de una serie de 34 casos

Introduction: Fournier's gangrene the of necrotizing fasciitis perineum and genital. The objetive of this study was to analyze our institution experience in the management of this pathology. Materials and methods: Descriptive and retrospective study of the patients with Fournier's gangrene treated in the Emergency Department of the Hospital General Universitario Gregorio Maranon between 1998 and 2008. Results: 34 patients were evaluated, 30 males and 4 females with a median age of 69 years. 30 patients suffered some predisposing factors, and the most common was arterial hypertension (n=18). Colorectal etiology were the most frequent (n=18). The most common clinical presentation were perineum pain (n=21) and erythema (n=19). Main laboratory results were hemoglobin 11.8 gr/dl, hematocrit 32,7%, white blood cells 17.300/mm3 (88,2% neutrophiles), INR 1,3 and urea 73,5 mg/dl. Surgical debridement is the m2ain treatment but complementary treatment such as cistostomy (n=3), colostomy (n=7) and orchiectomy (n=2) were needed. Microbiological cultures revealed Escherichia coli (63%), Bacteroides (55%) and Peptostreptococcus (42%). Imipenem (44%) and combination of penicillin, gentamicin and metronidazole (26%) were the most common empiric antibiotic therapy. Mortality was registered in 9 patients (26%). Conclusions: Fournier's gangrene exhibits low incidence at our institution. Colorectal etiology was the most common. The diagnosis was mainly clinic. Multidisciplinary treatment seems to be the best approach and includes hemodinamic support, surgery and broad-spectrum antibiotic therapy. The mortality rate was high.