%0 Journal Article
%T Fournier's gangrene ¨C analysis of 78 cases La gangrene perineale a propos de 78 observations
%A K Dj¨¨
%A R Lebeau
%A B Dian¨¦
%A CC Vodi
%A N Coulibaly
%A IS Sangare
%J African Journal of Urology
%D 2006
%I 
%X Objectives: To describe the epidemiologic, diagnostic and therapeutic aspects of Fournier's gangrene. Patients and Methods : This retrospective study was carried out on 78 patients (77 males and 1 female) treated for Fournier's gangrene at the University Hospital of Treichville, Abidjan, C te d'Ivoire, between January 1998 and October 2004. The patients' mean age was 43.3 years (range: 10 ¨C 80 years). Results: The median time elapsed between onset of the infection and consultation was 18 days. A port of entry and predisposing factors could be identified in 43 and 42 patients, respectively. The diagnosis was based on clinical examination. Escherichia coli and Enterobacter aeruginosa were the predominant microbial organisms isolated. Twenty-two patients had to be admitted for intravenous alimentation. All patients were treated by antibiotherapy, excision of necrotic tissues and subsequent wound dressing. Colostomy and cystostomy were performed in 14 patients each. Orchidectomy and penectomy were necessary in 5 and 3 patients, respectively. Healing was achieved without skin graft in 36 patients, while secondary suturing, skin graft and muscle flap were necessary in 18, 6 and 4 patients, respectively. Fourteen patients died from septic shock giving a mortality rate of 17.9%. Delayed consultation, shock and predisposing factors such as diabetes mellitus gave a poor prognosis. Conclusion: An early diagnosis, stabilization of the patient's hemodynamic status and debridement of the whole necrotic tissue combined with antibiotherapy will certainly reduce the risk of mortality in patients with Fournier's gangrene. R¨¦sum¨¦ Objectifs: D¨¦crire les aspects ¨¦pid¨¦miologiques, diagnostiques et th¨¦rapeutiques des gangr¨¨nes p¨¦rin¨¦ales. Mat¨¦riel et m¨¦thodes: Etude r¨¦trospective de Janvier 1998 ¨¤ Octobre 2004 dans le service d'urologie du CHU de Treichville, Abidjan, C te d'Ivoire. La s¨¦rie comportait 77 hommes et une femme d'un age moyen de 43,3 ans (extr¨ºmes: 10 et 80 ans) souffrant d'une gangr¨¨ne p¨¦rin¨¦ale. R¨¦sultats: Le d¨¦lai moyen de consultation ¨¦tait de 18 jours. Une porte d'entr¨¦e et une comorbidit¨¦ ont ¨¦t¨¦ trouv¨¦es chez respectivement 43 et 42 patients. Le diagnostic de la gangr¨¨ne p¨¦rin¨¦ale a ¨¦t¨¦ clinique. Escherichia coli et Enterobacter aeruginosa ¨¦taient les bact¨¦ries les plus fr¨¦quemment rencontr¨¦es. Vingt-deux patients ont ¨¦t¨¦ admis en r¨¦animation. Tous les patients ont eu un traitement antibiotique, une n¨¦crosectomie en urgence et des soins locaux quotidiens. Une colostomie et une cystostomie ont ¨¦t¨¦ n¨¦cessaires dans chaque cas chez 14 patients de m¨ºme qu'une orchidectomie et une p¨¦nectomie chez respectivement 5 et 3 patients. La cicatrisation s'est faite spontan¨¦ment chez 36 patients, a n¨¦cessit¨¦ une suture, une greffe de peau mince ou un lambeau chez respectivement 18, 6 et 4 patients. Quatorze patients (mortalit¨¦ 17,9%) sont d¨¦c¨¦d¨¦s dans un tableau de choc toxi-infectieux. Le retard ¨¤ la consultation, la pr¨¦sence d'un choc et d'une co-morbidit¨¦ nota
%U http://www.ajol.info/index.php/aju/article/view/8141