Fournier's gangrene: historic (1764-1978) versus contemporary (1979-1988) differences in etiology and clinical importance

Abstract

Experience with 11 cases of Fournier's gangrene during the decade 1979-1988, prompted this review of the English language literature to determine whether there have been changes in demography, etiology, and outcome, as compared to cases dating to 1763. All cases were evaluated according to age, sex, bacteriology, etiology, and outcome. In the decade 1979-1988, 449 cases were reported. The average age of the patients was 49.8 years; with 14 per cent occurring in females. Synergistic polymicrobial infections were present in all cases. The most commonly reported etiologies were colorectal (33%), idiopathic (26%), and genitourinary (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. Overall mortality was 22%. Comparison with 386 cases of Fournier's gangrene reported between 1763 and 1978 reveals that the mean age of patients remains relatively low, and males continue to predominate. The pathophysiologic 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.