La gangrene perineale a propos de 78 observations

ABSTRACT

Objectives: To describe the epidemiologic; diagnostic and therapeutic aspects of Fournier's gangrene. Patients and Methods: This retrospective study was carried out on 78 patients (77 males and 1 female) treated for Fournier's gangrene at the University Hospital of Treichville; Abidjan; Cote d'Ivoire; between January 1998 and October 2004. The patients' mean age was 43.3 years (range 10 - 80 years). Results: The median time elapsed between onset of the infection and consultation was 18 days. A port of entry and predisposing factors could be identified in 43 and 42 patients; respectively. The diagnosis was based on clinical examination. Escherichia coli and Enterobacter aeruginosa were the predominant microbial organisms isolated. Twenty-two patients had to be admitted for intravenous alimentation. All patients were treated by antibiotherapy; excision of necrotic tissues and subsequent wound dressing. Colostomy and cystostomy were performed in 14 patients each. Orchidectomy and penectomy were necessary in 5 and 3 patients; respectively. Healing was achieved without skin graft in 36 patients; while secondary suturing; skin graft and muscle flap were necessary in 18; 6 and 4 patients; respectively. Fourteen patients died from septic shock giving a mortality rate of 17.9. Delayed consultation; shock and predisposing factors such as diabetes mellitus gave a poor prognosis. Conclusion: An early diagnosis; stabilization of the patient's hemodynamic status and debridement of the whole necrotic tissue combined with antibiotherapy will certainly reduce the risk of mortality in patients with Fournier's gangrene