La gangrene perineo-scrotale : etiologies et therapeutiques : a propos de 60 cas

ABSTRACT

Objective To assess the epidemiological and diagnostic aspects; treatment and early and late outcomes of perineo-scrotal gangrene. Patients et Methods We report on 60 cases collected over a period of 14 years. The patients' mean age was 40 years. All patients were males. Twenty of them had diabetes. An aetiology was found in 47 cases. It was a urologic aetiology in 27 cases and a proctologic aetiology in 20 cases. 13 cases were considered as primitive and classified as Fournier's Gangrene. All patients were admitted to the emergency unit and underwent a large debridement with urinary diversion. A colostomy was done in 25 cases. A hyperbaric oxygenotherapy was administered in 30 cases. Results Ten patients died after a week due to a delayed diagnosis. 39 patients were cured primarily without sequelae and 11 others after reconstructive surgery using a cutaneous graft in 10 cases and a musculo-cutaneous graft in one case. Conclusion 20of cases of perineo-scrotal gangrene are idiopathic. Given the high mortality and morbidity; an early treatment associating intensive care; triple antibiotherapie; large debridement and; if possible; hyperbaric oxygenotherapy is necessary