Long-term functional outcomes of perineal gangrene: worse than expected?-an observational retrospective study.

PURPOSE: For survivors of perineal gangrene (PG), quality of life and functional prognosis of pelvic functions are probably overestimated. The aim of this study was to report long-term anal and urinary sphincter dysfunctions, sexual sequelae, and patients' quality of life after treatment of perineal gangrene. METHODS: This retrospective observational study was conducted in one university hospital over 16 years. Seventy-three patients experienced PG; 22 were subject to long-term follow-up. Three questionnaires were sent to patients to assess pelvic dysfunction and quality of life: the GIQLI, the Cleveland Incontinence Score, and the USP score for urinary dysfunction. Sexual sequelae were considered if orchiectomy or penile resection for male patients and vulvar resection for female patients were performed. RESULTS: Of the 72 patients included, seven died before discharge (9.7%) and at least 14 died during follow-up (19.4%), despite a mean age of 62 years (± 13). Among the surviving patients, seven experienced an alteration of their quality of life (44%) (GIQLI < 96). Six patients still had a colostomy, and among the remaining patients, 11 experienced minimal to mild incontinence (68.7%), while one experienced constipation (6.2%). One patient suffered from urinary incontinence (4.5%), and six suffered from dysuria (27.3%). Three male patients (14%) underwent an orchiectomy, and one female patient (100%) underwent a vulvar resection. CONCLUSION: PG leads to a high rate of anal and urinary dysfunctions. Urinary dysfunctions are taken into account and treated; however, anal incontinence is not investigated even though it could lead to decreased quality of life.

[Perineoscrotal gangrene after a snake bite: a case report]. / Un cas de gangrène périnéoscrotale consécutive à une morsure de serpent.

The authors describe a case of perinoscrotal gangrene in a patient who had been bitten by a snake. He was treated with antivenom immunotherapy and surgery. The outcome was good. They present a brief review of the literature regarding the epidemiological, clinical, and treatment issues.

Gangrena de Fournier: experiencia en el Hospital Barros Luco / Fournier-s Gangrene: Barros Luco Hospital experience

La gangrena perineal (enfermedad de Fournier) corresponde a una fasceítis infecciosa necrotizante de la región perineal, genital y/o perianal, de evolución fulminante y progresiva, asociada a una alta mortalidad. Se realizó una revisión retrospectiva de los pacientes atendidos en nuestro hospital con diagnóstico de egreso de gangrena perineal o enfermedad de Fournier, entre los años 2005 y 2008. De un total de 18 pacientes (100 por ciento hombres), la edad promedio fue de 55 años (rango de 34 a 81). En 15 casos (84 por ciento) fue posible determinar el foco, de éstos 6 (40 por ciento) fueron urológicos, 8 (53 por ciento) colorrectales, 1 (7 por ciento) dermatológico. Las condiciones predisponentes más frecuentes fueron diabetes mellitus (50 por ciento) y alcoholismo (33 por ciento). El germen más aislado en urocultivos fue E coli (75 por ciento) y en cultivos de secreción el S aureus (21 por ciento), en el contexto de cultivos con flora polimicrobiana. Sólo se logró aislar anaerobios en 2 casos. El promedio de días cama fue de 24 días (rango de 7 a 98). Se realizó un total de 59 intervenciones quirúrgicas con un promedio de 3,5 cirugías por paciente. La mortalidad en esta serie fue de 6 pacientes (33 por ciento). La enfermedad de Fournier continúa siendo una patología relevante en nuestro medio con una alta mortalidad, a pesar de un diagnóstico y tratamiento precoz y agresivo.

Perineal gangrene (Fournier’s disease) is an infective necrotizing fasciitis of the perineal, genital and/or perianal regions, with a progressive and fulminant evolution, and high mortality risk. We reviewed the record of the patients seen at our hospital with discharge diagnosis of perineal gangrene or Fournier´s disease, between years 2005 to 2008 and we found 18 patients (100 percent males). Average age was 55 years (range 34 to 81 ). In 15 cases (84 percent) we could find the source of infection, 6 (40percent) was urogenital, 8 (53 percent) anorectal, 1 (7 percent) cutaneous. The most common association was diabetes Mellitus (50 percent) and smoking (55 percent). The most frequently isolated germ in urine cultures was E coli (75 percent).From polymicrobial secretions culture, S aureus was the most frequently isolated (21percent).Only in two cases it was possible isolate anaerobic bacteria. The average of hospitalization was 24 days (range 7 to 98 ). A total of 59 surgical procedures were performed, with an average of 3,5 per patient. The mortality in this review was 6 patients (33 percent).Key words: Perineal gangrene, Fournier’s disease, perineal necrotizing fasciitis.