Comparative analysis of scoring systems for predicting mortality in Fournier gangrene: single center, 15 years experience.

To compare 5 published scoring systems (Fournier gangrene severity index [FGSI], Uludag FGSI [UFGSI], age-adjusted Charlson Comorbidity Index [ACCI] and the Quick Sequential Organ Failure Assessment (qSOFA) and the Laboratory Risk Indicator for Necrotizing fasciitis (LRINEC) scores and to evaluate risk factors for outcome prediction in patients with Fournier gangrene (FG). Between 2010 and 2024, 311 patients were included in the study. The data of 276 survivors and 55 non-survivors were compared. Univariate and multivariate analyses were performed to determine which of the 5 scoring systems calculated according to demographic, laboratory and clinical data predicted mortality better. In addition, a cut-off value for these scoring systems was determined by ROC analysis. The mortality rate was 17.6% in FG patients. In all 5 scoring systems, univariate analyses showed higher values in non-survivor patients, while UFGSI and FGSI scoring systems were superior to other scoring systems in multivariate analyses (p < 0.001). ROC analysis using mortality-based sensitivity and specificity revealed that the optimal cut-off values for FGSI, UFGSI, ACCI, SOFA and LRINEC should be equal to or higher than 10, 12, 4, 2 and 8, respectively. UFGSI and FGSI scores had the highest AUC values among all scores. This was followed by ACCI, qSOFAand LRINEC. For a UFGSI score ≥ 12, the sensitivity was 84%, specificity 97%, PPV 85% and NPV 97%. Among the scoring systems used to predict mortality, UFGSI was the most accurate, while LRINEC was the least accurate.

Higher Morbidity and Mortality in Women With Fournier Gangrene Compared With Men: Insights From National Inpatient Sample Data.

PURPOSE: To compare Fournier gangrene in female and male patients and identify mortality-associated characteristics in both. MATERIALS AND METHODS: We used National Inpatient Sample data (2016-2020) to identify Fournier gangrene cases and extracted demographic, comorbidity, and procedural variables. Multivariable regression models were used to identify mortality risk factors for both cohorts. RESULTS: We identified 2875 female (31%) and 6451 male patients (69%) with Fournier gangrene corresponding to an estimated 14,375 (95% CI, 13,784-14,966) and 32,255 (95% CI, 31,390-33,120) cases, respectively. Female patients were more likely to die than male patients (7.1% vs 5.7%, P < .0001, respectively). The median incidence rates were 1.7 (IQR, 1.5-1.8) and 4 (IQR, 3.6-4.3) cases per 100,000 person-years for female and male patients, respectively. Female patients had higher median age, longer hospital stays, more charges, procedures, and fecal diversion rates, but lower routine discharges than male patients (P < .05). Non-White female patients had increased mortality odds compared with White female patients (odds ratio [OR], 1.49; 95% CI, 1.07-2.07; P = .019). Prolonged interval until initial perineal debridement correlated with higher mortality odds in both female and male patients (OR, 1.02; 95% CI, 1-1.04; P = .034 vs OR, 1.03; 95% CI, 1.01-1.05; P < .0001). Diabetes lowered mortality odds in female and male patients (OR, 0.68; 95% CI, 0.47-0.99; P = .046 vs OR, 0.54; 95% CI, 0.41-0.7; P < .0001). CONCLUSIONS: In female patients, Fournier gangrene incidence surpasses previous reports, with slightly worse outcomes compared with male patients, emphasizing the need for precise clinical assessment and early intensive interventions.

National Study of Fournier Gangrene in Spain (2016-2021): Gender/Sex Differences in Mortality and Risks.

Background and Objective: The aim of this study was to analyze sex differences in risk factors associated with hospital mortality in patients with Fournier gangrene (FG). Materials and Methods: A retrospective population-based study (2016-2021) included FG hospitalizations in Spain. To identify the risk factors, we used multivariable logistic regression and reported adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: There were 3644 admissions for FG during the study period (82.5% men and 17.5% women). The mean hospitalization rate per 1000 admissions/year was 0.23 for men and 0.05 for women, and the mean hospitalization rate per 100,000 inhabitants/year was 2.7 for men and 0.4 in women. The most common comorbidities were hypertension (44.9%) and diabetes mellitus (35.6%). The main complications were sepsis (22.1%), 29.8% were admitted to the intensive care unit and 16.1% died. Mortality was higher in women (aOR 1.32, 95% CI 1.07-1.63). The main independent risk factors for mortality in the entire sample were older age, neoplasms, chronic kidney disease, heart failure, sepsis, acute kidney injury, and admission to the intensive care unit. In women, they were older age, leukemia, sepsis, acute kidney injury, and admission to the intensive care unit. Conclusions: The overall FG mortality rate was slightly higher in women than in men, people aged >64 years, people with chronic kidney disease, sepsis, and acute kidney injury, and admission to the intensive care unit. The independent factors associated with mortality in women were similar in both sexes.

Closure of the initial surgical wound resulting in successful treatment of a pediatric case of Fournier's gangrene: A case report.

Fournier's gangrene is a severe type of necrotizing fasciitis that affects the perineal and genital regions. Because of its rapid progression, Fournier's gangrene is associated with high mortality and morbidity rates. Surgical treatment of Fournier's gangrene requires leaving the wound open and performing multiple debridement procedures. We report a case of Fournier's gangrene caused by Streptococcus anginosus in a 9-year-old boy with severe autism. Because of the patient's condition, surgical treatment included thorough debridement and closure of the initial wound under general anesthesia. This case was successfully treated and the patient was discharged without infection recurrence.

Revisiting Fournier Gangrene: A Contemporary Epidemiological Perspective vs Perineal Cellulitis.

INTRODUCTION: We conducted a population-based analysis of Fournier gangrene (FG) to compare risk factors and mortality with those of perineal cellulitis. METHODS: We analyzed National Inpatient Sample data (2016-2020) to identify FG and perineal cellulitis cases. Demographic, comorbidity, and procedural data were extracted. Logistic models assessed risk factors of FG diagnosis and mortality. RESULTS: A total of 73,472 cellulitis and 9326 FG cases were identified corresponding to 74,905 (range, 63,050-79,165) and 9115 (range, 7925-11,080) median yearly weighted cases, respectively. FG diagnosis vs cellulitis was positively associated with Native American race (odds ratio [OR], 1.46; 95% CI, 1.19-1.79), weekend (OR, 1.12; 95% CI, 1.06-1.18) or December (OR, 1.33, 95% CI, 1.22-1.44) admissions, diabetes mellitus (OR, 2.51; 95% CI, 2.38-2.64), and malignancy (OR, 2.29; 95% CI, 2.07-2.54). Conversely, Hispanic (OR, 0.79; 95% CI, 0.74-0.85) and Asian/Pacific Islander races (OR, 0.83; 95% CI, 0.69-0.99) and the highest household income quartile (OR, 0.84; 95% CI, 0.78-0.90) were linked to a reduced likelihood of FG diagnosis. Elevated mortality risks were observed with female sex (OR, 1.33; 95% CI, 1.08-1.63), Native American ethnicity (OR, 2.29; 95% CI, 1.14-4.57), and procedural frequency (OR, 1.27; 95% CI, 1.24-1.3) among FG cases. CONCLUSIONS: Various patient and clinical factors are linked to the development and mortality of FG compared with perineal cellulitis. Improved access to care and understanding of FG can enhance patient outcomes.

Fournier's Gangrene Associated With Untreated Crohn's Disease in a Male Patient: A Case Report and Review of the Literature.

Crohn's disease is a chronic idiopathic inflammatory bowel disease that can affect any part of the gastrointestinal tract. Perianal symptoms are seen in one-third of Crohn's disease cases, with perianal abscesses leading to Fournier's gangrene being extremely rare. Herein, we discuss an interesting case of a male patient with Fournier's gangrene as a result of untreated Crohn's disease. A 51-year-old male presented to the emergency department with a perianal abscess and cellulitis of the perineum. Examination under general anesthesia (EUA) of the rectum and incision and drainage (I&D) of the abscess were performed urgently, leading to the diagnosis of Fournier's gangrene. Subsequent investigations revealed that the causative factor was a previously diagnosed but untreated Crohn's disease. The comprehensive treatment plan included fecal diversion, regular surgical debridement, negative pressure wound therapy, antibiotics administration, and perineal reconstruction. After a 37-day hospital stay, the patient was discharged in good clinical condition and referred to a specialized gastroenterologist for further treatment. A year later, he underwent an ileocecal resection with ileocolic anastomosis. In rare circumstances, Crohn's disease may manifest solely through perianal symptoms and, even more rarely, as Fournier's gangrene. It is crucial for clinicians to be aware of this manifestation for early diagnosis and prompt treatment. Maintaining a high level of suspicion, achieving early diagnosis, implementing prompt resuscitation, and adopting a multidisciplinary approach within specialized medical centers are crucial factors for effective management in these cases.

Validation of necrotising infection clinical composite endpoint in a retrospective cohort of patients with necrotising soft tissue infections.

Introduction: Rapidly progressive necrotising soft tissue infections (NSTIs) are associated with high mortality and morbidity. Low incidence and disease heterogeneity contribute to low event rates and inadequately powered studies. The Necrotising Infections Clinical Composite Endpoint (NICCE) provides a binary outcome with which to assess interventions for NSTIs. Partly with a view towards studies of hyperbaric oxygen treatment in NSTIs we aimed to validate NICCE in a retrospective cohort of NSTI patients. Methods: Eligible patients were admitted between 2012 and 2021 to an adult major referral hospital in Victoria, Australia with surgically confirmed NSTI. The NICCE and its constituents were assessed in the whole cohort (n = 235). The cohort was divided into two groups using the modified sequential organ failure assessment (mSOFA) score, with an admission mSOFA score ≥ 3 defined as high acuity. Results: Baseline characteristics of the whole (n = 235), the high (n = 188) and the low acuity cohorts (n = 47) were similar. Survival rates were high (91.1%). Patients with an admission mSOFA ≥ 3 were less likely to meet NICCE criteria for 'success' compared to the lower acuity cohort (34.1% and 64.7% respectively). Meeting NICCE criteria was significantly associated with lower resource utilisation, measured by intensive care unit days, ventilator days, and hospital length of stay for all patients and for those with high acuity on presentation. Conclusions: The NICCE provides greater discriminative ability than mortality alone. It accurately selects patients at high risk of adverse outcomes, thereby enhancing feasibility of trials. Adaptation of NICCE to include patient-centred outcomes could strengthen its clinical relevance.

Management of neglected urethral stone and Fournier's gangrene as its complication: A case report.

INTRODUCTION AND IMPORTANCE: Fournier's gangrene (FG) is a rare necrotizing fasciitis, and it's a urological emergency. Another disease that can cause FG is urethral stones. This case report is prepared to discuss the management of neglected urethral stones and Fournier's Gangrene, as well as its complications. CASE PRESENTATION: A 49-year-old male presented to the emergency room (ER) referred from the public health centre with a swollen and infected scrotum 2 weeks ago. It was worsened 1 day before hospital admission, accompanied by the discharge of pus from the scrotum. The patient also complained presence of intermittent fever, nausea, and vomiting. There was a history of straining when urinating. Physical examination showed a lump at the penis and crepitation at the scrotum. Radiological examination of the kidney ureter and bladder (KUB) x-ray and urethrography showed the presence of gangrenous gas at the scrotum. In this case, we perform open cystostomy, debridement necrotomy, and removal of urethral stone. CLINICAL DISCUSSION: Management of neglected urethral stones and Fournier's Gangrene cases needs to be done immediately to prevent poor outcomes. Necrotomy debridement management is performed immediately as a source of infection. Open cystostomy as a urinary diversion is performed so that urine does not pass through the urethra and the healing process of the urethra can be maximized. CONCLUSION: Controlling the source of infection and urinary diversion is important in cases where neglected urethral stones and Fournier's gangrene are found.

Outcome of Fournier's gangrene in relation to Fournier Gangrene Severity Index (FGSI) score.

Introduction: Fournier's gangrene is a rapidly progressive necrotizing fasciitis, involving perineum mainly. The purpose of the study is to evaluate etiology, treatment, and outcome of Fournier's gangrene so that such type patient's management can be done by primary care physicians with best outcomes. Method: This was a retrospective study including 156 patients, treated for Fournier's gangrene, between Jan 2012 and Dec 2018. The outcome and prognosis of Fournier's gangrene were reviewed. Result: The mean age and mode among survival patients were 47.94 ± 14.9 and 60 years, and the mean age and mode in nonsurvival patients was 47.64 ± 15.9 and 65 years. The most common predisposing factor was diabetes mellitus (n = 49, 31.4%) having mortality rate was 9% (n = 14). Most common causative bacteria were E. coli. In the study, the survival rate was 100% in patients having Fournier Gangrene Severity Index (FGSI)≤3. As FGSI increased from 3, the mortality rate increased. Conclusion: Fournier gangrene is a surgical emergency. Early diagnosis, serial surgical debridement, and broad-spectrum antibiotics decrease the mortality and morbidity of patients. The sensitivity and specificity of FGSI determine the prognosis of Fournier's gangrene. FGSI is a simple method to know the severity and prognosis.

An Uncommon Consequence of Perforated Acute Appendicitis in Elderly Patients: Fournier's Gangrene.

Acute appendicitis that is not diagnosed and treated promptly typically results in serious complications that raise the risk of necrotizing fasciitis, particularly in elderly patients. We present a case of a 77-year-old male, who presented to the emergency department with a clinical manifestation of Fournier's gangrene caused by acute perforated appendicitis. The patient had no symptoms or signs of an acute abdomen, and within three days he developed significant unilateral scrotal swelling and skin changes. Our case demonstrates the need to treat Fournier's gangrene as a consequence of an intra-abdominal infectious disease, particularly in elderly comorbid patients with atypical symptoms of acute appendicitis, and highlights the importance of early surgical intervention.

Fournier's Gangrene: clinical case review and analysis of risk factors for mortality.

BACKGROUND: Fournier's Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier's Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives. METHODS: This study included 46 hospitalized patients diagnosed with Fournier's Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher's exact test. Differences between numerical variables were compared using Student's t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier's Gangrene. RESULTS: Among the 46 Fournier's Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age (P<0.05), extension to the abdominal wall (P<0.01), hematocrit (P<0.01), albumin (P<0.01), SFGSI (P<0.01), and SFGSI>2 (P<0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier's Gangrene patients. CONCLUSION: This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier's Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates.

Case report: is necrotizing fasciitis in a rectal cancer patient after targeted systemic therapy related to the tumor site? - evidence from a hepatocellular carcinoma patient.

Necrotizing fasciitis (NF) is a rare and life-threatening serious infectious disease, characterized by acute onset and rapid progress, leading to extensive necrosis of skin, soft tissue as well as fascia by a variety of aerobic and anaerobic bacteria, localized on external genitalia, scrotum, groin and perianal areas in males. There exist numerous common etiologies for NF, yet NF induced by malignant neoplasms is exceedingly rare. Several studies have reported that NF may be associated with tumor site (rectal/sigmoid colon cancer) and blood supply dysfunction caused by targeted therapy drugs (bevacizumab, aflibercept, ramucirumab). The perforation of colorectal cancer poses a unique risk factor for NF. However, in our two cases, the patient with rectal cancer received CapeOX (oxaliplatin + capecitabine) + bevacizumab + tislelizumab for 3 cycles without perforation but did develop NF. One month after debridement, the patient continued immunotherapy with tislelizumab alone for the fourth cycle and maintained for an additional 3 cycles without any recurrence of NF. Therefore, does the occurrence of NF correlate with the tumor site (rectum) and targeted immunotherapy? Another patient with hepatocellular carcinoma also developed NF after receiving 2 cycles of lenvatinib + sintilimab treatment. The third cycle of sintilimab immunotherapy was administered on the 13th day after operation, which was subsequently maintained for an additional 2 cycles without recurrence of NF. The absence of a direct correlation between hepatocellular carcinoma and rectal tumor location as well as immunotherapy, suggests that NF may be closely linked to targeted therapy.

Limb Salvage in Extensive Necrotizing Soft Tissue Infection with Adjuvant Hyperbaric Oxygen Therapy.

A necrotizing soft tissue infection (NSTI) can be life-threatening if not treated promptly, posing a high risk of limb amputation. Here, we report a case of an NSTI extending from the buttocks and perineum down to the left lower limb. The case involved a 48-year-old male patient who presented with fever, altered consciousness, and limb swelling. Computed tomography showed the infection had spread to the perifascial, intermuscular, and intramuscular regions, making it difficult to save the patient's life and limb. Despite prompt surgery and antibiotic treatment, multidrug-resistant bacteria presented difficult wound management challenges. Hyperbaric oxygen therapy (HBO) was initiated, which resulted in dramatic wound improvement and successful skin grafting. Due to limb preservation, the patient was able to recover his preadmission activities of daily living and successfully reintegrate into society. Standard treatments for NSTI include early surgical treatment, antibiotics, and intensive support. The adjunctive use of HBO therapy may have contributed to the successful outcome in this case.

Fournier's Gangrene reconstruction in black patients using SCIP flap and split thickness skin graft: 2 case reports and a literature review.

Fournier's gangrene is a potentially life-threatening infectious disease involving the perineum and genitals. Aggressive surgical and medical management is often required, leaving the patient with large integumentary defects. The multiplicity of reconstructive options reported highlights the lack of consensus on the best covering option. Functional and aesthetic considerations are in play, and the literature is scarce on male black patients. We report here two cases of dark-skinned patients presenting with scrotal and penile integumentary defects that were respectively reconstructed with a superficial circumflex iliac artery propeller perforator flap and a split-thickness meshed skin graft and discuss the available literature on the topic.

Prognostic factors and clinical outcomes in Fournier's Gangrene: a retrospective study of 35 patients.

BACKGROUND: Fournier's gangrene is a severe form of infectious necrotizing fasciitis affecting the perineum, perianal, and genital areas; it is associated with substantial morbidity and mortality. Hence, it is important to identify prognostic factors that can predict clinical outcomes and guide treatment strategies. Thus, our study aimed to analyze patient characteristics and determine prognostic factors affecting clinical outcomes in Fournier's gangrene. METHODS: This retrospective study involved examining medical records spanning 18 years for patients with Fournier's gangrene at our institution. Considering the exclusion criteria, data from 35 patients were included in this study. RESULTS: A total of 35 patients were included in the analysis. The mean age of the patients showed no statistically significant difference between the survivor and non-survivor groups. The Charlson Comorbidity Index, American Society of Anesthesiologists score, and Acute Physiology and Chronic Health Evaluation II score were not significantly different between the two groups. Notably, the initial Sequential Organ Failure Assessment score was significantly higher in the non-survivor group than that in the survivor group. The overall in-hospital mortality rate was 17.1%. Moreover, the prevalence of multidrug resistant bacterial infection was markedly higher in the non-survivor group than that in the survivor group. Coagulation dysfunction was significantly more prevalent in the non-survivor group than that in the survivor group, and had the most significant impact on in-hospital mortality. A multivariable logistic regression analysis identified multidrug resistant bacterial infection to be independently associated with high in-hospital mortality. CONCLUSIONS: Coagulation dysfunction and multidrug resistant bacterial infection were identified as independent negative prognostic factors, highlighting the need for prompt monitoring and proactive strategies against Fournier's gangrene.

Gangrena de Fournier secundaria a cuerpo extraño: Reporte de caso / Fournier's gangrene secondary to a foreign body: Case report

Introducción. La gangrena de Fournier es un proceso infeccioso progresivo que compromete piel, tejido celular subcutáneo, grasa y fascia subyacente, con una incidencia de 1,6 pacientes por cada 100.000 personas/año. Se considera una urgencia quirúrgica, que requiere de manejo oportuno, ya que puede llegar a ser fatal, con una tasa de mortalidad del 20 al 35 %, que es más alta en hombres, en la tercera década de la vida y en pacientes inmunocomprometidos. Caso clínico. Se presenta el caso clínico de un paciente masculino de 44 años de edad, quien cursó con gangrena de Fournier secundaria a una espina de pescado de 5 cm de largo, incrustada en la unión anorrectal. Resultados. El paciente fue manejado por urología y cirugía general, requirió hospitalización en la Unidad de Cuidados Intensivos y curaciones por parte de terapia enterostomal, con resultados satisfactorios. Conclusiones. Sus posibles causas son múltiples y en ocasiones puede ser desencadenada por un factor externo, como un cuerpo extraño. Uno de los factores predisponentes es la obesidad. El diagnóstico oportuno y un tratamiento con intervención multidisciplinaria mejoran la sobrevida y la calidad de vida de los pacientes.

Introduction. Fournier's gangrene is a progressive infectious process that involves skin, subcutaneous tissue, fat and underlying fascia, with an incidence of 1.6 per 100,000 people/year. It is considered a surgical emergency, which requires timely management since it can be fatal, with a mortality rate of 20 to 35%, which is higher in men, in the third decade of life and in immunocompromised patients. Clinical case. Clinical case. A 44-year-old male patient is presented with Fournier's gangrene secondary to a 5 cm long fishbone embedded in the anorectal junction. Results. The patient was managed by urology and general surgery, requiring hospitalization in the ICU and treated by enterostomal therapy with satisfactory results. Conclusions. Its possible causes are multiple and sometimes it can be triggered by an external factor, such as a foreign body. One of the predisposing factors is obesity. Timely diagnosis and treatment with multidisciplinary intervention improve survival and quality of life of patients

Description of Transperineostomal Resection of the Prostate: A Case Report.

We report a case of transperineostomal bipolar resection of the prostate (TPR-P) for lower urinary tract symptoms (LUTS). To our knowledge, this is the first description in the scientific literature. A 67-year-old man with a medical history of multiple penile debridements and formation of a perineostomy due to an episode of severe Fournier's gangrene in 2015, was admitted to the emergency room with acute urinary retention. Consecutively, a suprapubic catheter was inserted. Attempts of catheterization failed due to bulbar stenosis and an obstructive prostatic urethra. After the resolution by dilatation of the bulbar stenosis, post-voiding residual volume persisted at up to 150 ml. The intra- and postoperative course after TPR-P was uneventful. No adverse events occurred. The assessment after six weeks revealed an International Prostate Symptom Score (IPSS) improvement of nearly 50% for the symptoms and >60% for overall satisfaction (preoperative: IPSS: S=24, L=6; postoperative IPSS: S=13, L=2). The average post-voiding residual volume decreased from 150 ml preoperatively to 15 ml (range 0-30 ml) postoperatively. Due to the missing full length of the urethra, the augmented range of motion seemed almost too loose for classic resection techniques in our hands. Therefore, we believe that in such cases it might be advantageous to use enucleation techniques. However, in our case, TPR-P was feasible and safe with a good functional outcome.

Can the SIARI score be used at initial admission to predict testes involvement in patients with fournier's gangrene; a single-centre, retrospective study.

BACKGROUND: To predict testicular involvement in patients diagnosed with Fournier's gangrene (FG) using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and the site other than lower limb (SIARI) score. METHODS: The medical records of 51 patients operated for FG in our clinic between December 2012 and April 2022 were evaluated retrospectively in this study. Patients' demographics, and laboratory test results were compared with the testisticular involvement status. Patients with testisticular involvement (n = 10) were compared with patients without testicular involvement (n = 41). The SIARI score at initial admission was analysed using logistic regression analyses for its performance in predicting testicular involvement with FG. Receiver operating characteristics (ROC) curves and the area under the receiver operating characteristic curve (AUROC) were used to evaluate its discriminating ability. RESULTS: The SIARI score had modest performance for diagnosing testicular involvement in FG patients, with ROC analysis showing an AUROC value of 0.83 (p < 0.001). With a SIARI cut-off score of ≥ 3, the sensitivity was 90% and the specificity was 68%. For a SIARI cut-off score of ≥ 5, the sensitivity was 40% and the specificity was 97%. CONCLUSIONS: The ability of the SIARI score to discriminate FG with testicular involvement is modest. The SIARI score should be employed cautiously as a routine diagnostic tool for the prediction of testicular involvement in FG at the initial admission. More research is needed to develop a better understanding of the relationship between the SIARI score and testicular involvement in FG.

Fournier's Gangrene in an Elderly Male: A Case Report.

Fournier's gangrene (FG) is a rapidly progressing necrotizing soft tissue infection of the perineum with potential multiorgan involvement, posing significant mortality risks. This case report highlights the clinical presentation, potential risk factors, and emphasizes the critical necessity of immediate antibiotic therapy and surgical debridement, regardless of the causative agents involved. We also aim to provide new images to better visualize a diagnosis of Fournier's gangrene. We present the case of a 65-year-old male with a history of self-care neglect, hypertension, and extensive tobacco use. The patient presented to the emergency department exhibiting classical symptoms of systemic illness, necessitating a collaborative diagnostic and therapeutic approach involving various medical specialties including family medicine, urology, general surgery, interventional radiology, infectious disease, pharmacy, intensive care, social service, and palliative care teams. Despite aggressive interventions during his 24-day hospitalization, the patient's clinical condition progressively deteriorated. This case underscores the significance of early detection, timely intervention, and interdisciplinary cooperation in optimizing outcomes for patients with Fournier's gangrene.

A Rare Case of Necrotizing Fasciitis in a Female With Diabetes Mellitus.

Fournier's gangrene (FG) is a relatively rare yet profoundly severe disease. It predominantly affects males; however, mortality rates are comparatively elevated in females. It is a rapidly spreading, life-threatening necrotizing fasciitis that can affect all parts of the body but primarily targets the genital region and the perineum. The clinical presentation is highly characteristic of the disease and is often sufficient for reaching a definitive diagnosis. Common risk factors for the development of this condition include diabetes mellitus (DM), obesity, trauma, alcoholism, smoking, arterial hypertension (which predisposes to obstructive endarteritis), and immunosuppressive disorders, such as HIV and cancer. Prompt diagnosis and treatment are imperative for the prognosis and survival of patients. Herein, we present a case of a 33-year-old woman with a medical history of type 1 diabetes mellitus (treated with insulin), arterial hypertension, and obesity. She presented with pain and swelling in the external genitalia (right labia majora), which later progressed to severe necrotizing fasciitis. The patient underwent surgical debridement and drainage, along with intensive medical therapy.