GANGRENE OF THE PERINEUM

Fournier's gangrene, an anaerobic necrotizing cellulitis of the infrad iaphragmatic soft tissues, is a serious pathologic entity with an unpr edictable course, From 1978 to 1991, a total of 24 men (mean age, 57 y ears; range 27 to 90) were treated for this entity at our institution. Diagnosis prompted immediate institution of multimodal treatment comb ining triple antibiotics, surgical dissection, debridement, and repeat ed surgical drainage, Fecal diversion (16 patients), hyperbaric oxygen ation, and standard intensive care procedures were widely indicated an d performed quasi-systematically. The mean interval between initial sy mptoms and diagnosis was 7.4 days. Lesions were limited to the perineu m in 11 patients but extended to the abdomen, thighs, or loins in the remaining 13. The pathogens were identified in 19 patients, and hemocu lture results were positive in 5. A coloproctologic origin was identif ied in 12 patients and a urogenital origin in 4. In 2 patients, perine al gangrene occurred postoperatively, and no etiology was determined f or 6. Six patients died, and 18 patients recovered, without any sequel ae. The prognosis is better when the patient is young (less than 60 ye ars old), has clinically localized disease, without systemic involveme nt, and sterile hemocultures and is managed with a colostomy, A thorou gh workup is mandatory to determine the etiology (locoregional lesion, malignancy, hemopathy, arteritis).