FOURNIERS GANGRENE - HISTORIC (1764-1978) VERSUS CONTEMPORARY (1979-1988) DIFFERENCES IN ETIOLOGY AND CLINICAL IMPORTANCE

Experience with 11 cases of Fournier's gangrene during the decade 1979 -1988, prompted this review of the English language literature to dete rmine whether there have been changes in demography, etiology, and out come, as compared to cases dating to 1763. All cases were evaluated ac cording to age, sex, bacteriology, etiology, and outcome. In the decad e 1979-1988, 449 cases were reported. The average age of the patients was 49.8 years, with 14 per cent occurring in females. Synergistic pol ymicrobial infections were present in all cases. The most commonly rep orted etiologies were colorectal (33%), idiopathic (26%), and genitour inary (21%). Mortality associated with colorectal etiology was highest (33%, p < 0.05). Female mortality (49%) was not significantly greater than male mortality (17%), when obstetrical etiology was excluded. Ov erall mortality was 22%. Comparison with 386 cases of Fournier's gangr ene reported between 1763 and 1978 reveals that the mean age of patien ts remains relatively low, and males continue to predominate. The path ophysiologic aspects of this disease appear similar in both sexes. The mortality rate from colorectal sources is significantly greater than from other common causes. Neither the introduction of antibiotics nor the development of newer ones has reduced mortality significantly. In spite of newer diagnostic techniques, the etiology remains unclear in over one-fourth of cases.