Enterostomy can decrease the mortality of patients with Fournier gangrene

Abstract

Aim: To determine the significance of enterostomy in the emergency management of Fournier gangrene.

Methods: The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed.

Results: The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P < 0.05) and average length of hospital stay (14.3 ± 7.8 d vs 20.1 ± 8.9 d, P < 0.05) were shorter in the enterostomy group. The case fatality rate was lower in the enterostomy group than that in the control group (3.6% vs 21.7%, P < 0.05).

Conclusion: Enterostomy can decrease the case fatality rate of patients with Fournier gangrene.

Keywords: Enterostomy; Fournier gangrene; Infection; Necrotizing fasciitis; Surgery.

Figure 1

Abdominal computed tomography scan. The scan shows diffuse edema, thickness of the perineum, and the presence of small bubbles.

Figure 2

Case of Fournier’s gangrene after surgical debridement (A), or after enterostomy (B).