AI Summary & Key Takeaways
AI InsightThe overall mortality rates were 40 % in all patients, 66.6 % in patients who did not receive hyperbaric oxygen treatment while adjuvant hyperbaric oxygen treatment resulted with 22.2 % mortality rates.
📌 3 Key Takeaways
Abstract
Background: Fournier's gangrene is synergistic necrotizing fasciitis of the perineum, perianal region and genitalia commonly originated from colorectal and genitourinary pathologies. Late diagnosis and insufficient treatment modalities might end in failure with high morbidity and mortality. Hyperbaric oxygen which enhances tissue growth and viability has been available as an adjunctive treatment modality. Patients and Methods: Medical charts of 15 patients with Fournier's Gangrene who were hospitalized in the Department of Surgery between 1998-2003, were retrospectively analyzed. Four patients were females and 11 patients were males with a mean age of 55.9 (40-78). Hyperbaric oxygen was applied to 9 patients as an adjuvant therapy. Treatment results and factors effecting the morbidity and mortality were evaluated. Results: The most prominent pathology which caused Fournier's Gangrene was perianal abscess in 9 patients (60 %), ischiorectal abscess in 2 patients (13%), scrotal folliculitis in 2 patients (13%), haemoroidectomy in 1 patient (7%) and cystoscopy in 1 patient (7%). Diversion colostomy was performed in 6 cases (% 40). The overall mortality rates were 40 % in all patients, 66.6 % in patients who did not receive hyperbaric oxygen treatment while adjuvant hyperbaric oxygen treatment resulted with 22.2 % mortality rates. Conclusion: Early diagnosis and wide excision of necrotic tissue with wide spectrum antibiotherapy are the main treatment modalities in the management of patients with Fournier's Gangrene. Diverting colostomy should be applied in the presence of anal sphincter insufficiency and rectal perforation or fistula in order to prevent the fecal contamination. Although the number of patients is small, hyperbaric oxygen as an adjuvant treatment seems to have favorable effects on morbidity and mortality.
Özet
Giriş: Fournier Gangreni, sıklıkla kolorektal ve genitoüriner kaynaklardan köken alarak perianal ve genital bölgeleri tutan, mortalitesi ve morbiditesi yüksek sinerjistik infektif nekrotizan fasitistir. Hiperbarik Oksijen tedavisi anaerobik bakteriler üzerindeki bakteriostatik- bakteristik ve antitoksik etkileri, yara iyileşmesini ve fibrosisi artıcı etkileri ile tedavi protokollerinde önerilen bir seçenektir. Hastalar ve Metotlar: Fournier Gangreni tanısı ile 1998-2003 yılları arasında kliniğimizde tedavi gören 15 hastanın dosya kayıtları retrospektif olarak incelendi. Hastaların 4'ü kadın 11'i erkek olup yaş ortalamaları 55.9 (40-78) idi. Hastalardan 9'una Hiperbarik Oksijen tedavisi uygulandı. Hastalara ait risk faktörleri, mortaliteye etki eden prognostik faktörler ve tedavi sonuçları irdelendi. Bulgular: Hastalarda gangrene neden olan en sık sebep, 9 olguda (% 60) perianal abse, 2 olguda (%13) iskiorektal abse, 2 olguda (%13) skrotal fronkül, bir olguda (%7) hemoroidektomi, bir olguda ise (%7) sistoskopi idi. Altı olguda (% 40) saptırıcı kolostomi uygulanmıştır. Mortalite hızları olguların tamamında % 40, Hiperbarik Oksijen tedavisi uygulanmayan olgularda % 66.6, uygulanan olgularda % 22.2 olarak belirlenmiştir. Sonuç: Erken tanı, nekrotik dokuların geniş debritmanı, geniş spektrumlu antibiotikler, ciddi perianal ve genital kontaminasyon olasılığında saptırıcı kolostomi Fournier Gangrenli olgularda temel tedavi prensipleridir. Temel tedavi prensiplerine ilaveten Hiperbarik Oksijen tedavisinin, yara iyileşmesini artırıcı yönü ile morbidite ve mortalite üzerinde olumlu etki gösterdiği anlaşılmaktadır.