Fournier’s Gangrene: Descriptive Analysis and Outcome of Eleven Cases

Special Article - Fournier Gangrene

J Bacteriol Mycol. 2017; 4(1): 1042.

Fournier’s Gangrene: Descriptive Analysis and Outcome of Eleven Cases

Jarboui S¹*, Bekkey MA², Triki H¹, Farhat I¹ and Lepandatu A²

¹Department of General Surgery, Mahmoud Matri Hospital, Ariana, Tunisia

²Department of General Surgery, Sidi Bouzid Hospital, Tunisia

*Corresponding author: Slim Jarboui, Department of General Surgery in Mahmoud Matri Hospital, Ariana, Tunisia

Received: December 05, 2016; Accepted: February 08, 2017; Published: February 10, 2017


Background: Fournier’s Gangrene (FG) is a rare but potentially life threatening extensive fasciitis of the external genitalia and perineum.

Aim of the Study: The aim is to describe the clinical features of patients treated on for FG and their hospital outcome after surgery.

Patients and Methods: Between 2010 and 2014, 11 patients with FG were enrolled in the department of general surgery of Sidi Bouzid Hospital - Tunisia.

Results: Eight male and three women were enrolled in the study. Six patients had diabetes. All patients were treated with common approach board spectrum antibodies, wide surgical excision with systematic revision. Three patients had had Hyperbaric Oxygen Therapy (HOT) and three had had colostomy. One patient treated with vacuum therapy. The course was uneventful in 10 cases and one patient died of pulmonary embolism.

Conclusion: Early diagnosis and management are essential in the case of FG because the risk of rapid extension and overwhelming sepsis is real leading to high rate of mortality.

Keywords: Fournier’s gangrene; Sepsis; Perineal gangrene; Surgical excision


Fournier’s Gangrene (FG) is a life-threatening necrotizing fasciitis of the perineal, genital and perineal regions. Mortality has been reported in different series to range from 20 to 50% [1-2]. This disease is worldwide and, is recognized more frequently among male adults. Early surgical debridement and administration of broadspectrum antibiotics are fundamental in the treatment of FG. Surgical reconstruction may follow when necessary.

The purpose of this study is to report our experience over the past 5 years regarding the management of FG and to assess retrospectively the rate of the severity and its reliability to predict the post operative outcome.

Patients and Methods

The medical records of all consecutives patients with Fournier’s Gangrene (FG) who were treated in the department of General Surgery at Sidi Bouzid Hospital –Tunisia between 2010 and 2014. Data were retrospectively collected about medical history and co morbidities, symptoms, physical examination, laboratory tests, imaging results, etiology, timing of surgical excision, antibiotics treatment, extent of surgical debridement, length of stay in the Unit of Intensive Care (ICU), respiratory assistance, number of excision under anesthesia, length of hospital stay and the post treatment course (mortality).

Diagnosis of FG was made on clinical characteristics in all patients with local sign of edema, erythema, tenderness, bleb formation or gangrene on physical examination.

The topography extent of the fasciitis and necrosis was appreciated pre and per operatively (confirmed by photos) ranging from those localized in the perineal region, those extended to the fesses region and/or to the roots of the lumbs, and/or to the abdominal or chest wall.

We calculated retrospectively the Fournier’s Gangrene Severity Index Score (FGSIS) for all patients to evaluate the gravity of the pathology. In this score, nine parameters were calculated: temperature, heart rate, respiratory rate, serum sodium, potassium, creatinine, bicarbonates level, hematocrit and leukocyte count.

Cephalosporin third generation, aminoglycosides and Metronidazole were used as combination in all patients. Surgical debridement was performed in emergency with extensive and aggressive approach depending on the extent of the necrotic tissues. Culture samples were taken from the wounds or pus and addressed for bacteriologic analysis. Aggressive debridement with resection of the necrotic skin, subcutaneous tissue, fascia and muscle until viable tissue was reached. Systematic revision under anesthesia was performed for all patients 24 to 48 hours after the first surgery. The bedside debridement was usually performed under general anesthesia. The number of iterative surgical revision, dressing change in the operating room and the indication of colostomy depends on the local evolution and the risk of fecal contamination of the operative wound.


Between 2010 and 2014, eleven patients with FG were enrolled in the department of General Surgery at the Sidi Bouzid Hospital in Tunisia. The average age was 38.2 years (range 17-65 years). There were eight male and three women. Six patients had diabetes mellitus and two were obese. The most common etiologic factor for FG was perineal abscess (six cases). Figure 1 and Figure 2 describe the local examination of two patients of them (Obs. 2 and 3). In one case, FG had complicated the post operative course of hemorrhoidectomy (Obs.4 and Figure 3A) and in one case (Obs. 5), the etiology was a bartholinite (Figure 4). The mean time to diagnosis was 4.3 days (range: 1-8 days).