[Perineo-scrotal gangrene: apropos of 31 cases].
Fournier's gangrene is a fascitis of the perineum and of the external genitalia. It is a serious infection with rapid evolution and a severe prognosis. It is also unpredictable towards the necrosis. It concerns a series of 31 cases of the perineal scrotal gangrene supervised in the department of surgical visceral emergency of the Ibn Rochd University hospital of Casablanca between 1992 and 2000. In this investigation, the male predominance is important and the mean age is 49 years. The diagnostic delay is 12 days. The symptomatology was dominated by edema and erythema signs, fever and pain. The skin necrosis was seated in the perineum and the scrotum. A septic shock was noticed in six patients and a condition of deep coma in two other patients. Etiology of gangrene was of coloproctologic origin in 15 cases and of urogenital origin in five patients. The bacteriological parietal swabs was positive in 11 cases. The therapeutic take-in-charge consisted of urgent measures of reanimation for six patients. The likely wide spectrum antibiotic therapy consisting of a triple association (beta lactam antibiotic, nitrite-imidazole compound and aminoglycoside) with a secondary adaptation that was recommended for all patients. All the patient underwent surgical debridement of the necrotic tissue with incisions and drainage of the involved areas of the of all the operated-on patients, 26 had colostomy, five among them had both colostomy and cystostomy. The overall evolution was favorable except in eight cases of death. In all, the authors insist on the positive diagnosis as well as the early take-in-charge of the disease to avoid complications of local or general order and recommended the preventive treatment with the precocious treatment of the causing infection.
el Mejjad
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Service des urgences chirurgicales viscérales, CHU Ibn Rochd, Casablanca, Maroc. amineelmejjad@hotmail.com
Belmahi
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Choukri
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A
Kafih
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M
Aghzadi
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Zerouali
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ON
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D004322:Drainage; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D018934:Fournier Gangrene / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy; D005832:Genital Diseases, Male; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D010502:Perineum; D012611:Scrotum
D000900:Anti-Bacterial Agents