title: Fournier gangrene. Approaches to diagnosis and treatment.
abstract: OBJECTIVE
  To investigate the factors associated with patients with Fournier's gangrene, and to clarify the effect of diabetes mellitus (DM) as a comorbid disease on morbidity and mortality of patients with Fournier's gangrene.
  
  
  METHODS
  Twenty-six Fournier's gangrene patients who were admitted to the Emergency Department of Ankara Numune Teaching and Research Hospital, Ankara, Turkey from 1997 to 2003 were examined retrospectively.
  
  
  RESULTS
  The mean age of the patients was 52.8 years. There were 8 female (30.8%) and 18 male (69.2%) patients. The etiological causes were as follows: diseases of the perianal region, history of operations, trauma and injections. Major comorbid disease states were diabetes mellitus (DM) and hypertension. The lesions in Fournier's gangrene were most commonly located in the perineum and genital region. Female patients with diabetes mellitus had significantly unusual extensive involvement, especially abdominal wall involvement. The most frequently isolated pathogen was Escherichia coli, while staphylococcal infection was most commonly seen in the presence of DM. Colostomy was performed on 53.8% of the patients, and cystostomy on 7.6% of the patients. Average time of staying at the hospital was 25 days with a mortality rate of 34.6%. Patients with DM had high mortality rates and stayed longer at the hospital than the non-diabetic patients.
  
  
  CONCLUSIONS
  In addition to early diagnosis, early and aggressive debridement and administration of multiple wide spectrum antibiotics chosen for the causative agent are the golden standard for decreasing the mortality and morbidity. Diabetes mellitus has been found to be an important factor to increase mortality rates of patients with Fournier's gangrene.
authors.affiliation: Harbiye Mah. S. A. Yakupoglu Sokak, 30/29, 06460, Dikmen, Ankara, Turkey. bulent72unal@hotmail.com
authors.forename: Bulent
authors.initials: B
authors.lastname: Unal
authors.forename: Belma
authors.initials: B
authors.lastname: Kocer
authors.forename: Ebru
authors.initials: E
authors.lastname: Ozel
authors.forename: Betul
authors.initials: B
authors.lastname: Bozkurt
authors.forename: Osman
authors.initials: O
authors.lastname: Yildirim
authors.forename: Buket
authors.initials: B
authors.lastname: Altun
authors.forename: Mete
authors.initials: M
authors.lastname: Dolapci
authors.forename: Omer
authors.initials: O
authors.lastname: Cengiz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy; D048909:Diabetes Complications / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D018934:Fournier Gangrene / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000473:pathology