Fournier's Gangrene as Seen in University of Maiduguri Teaching Hospital

Background. Fournier’s gangrene is uncommon but increasingly being seen over the last two decades probably due to increasing socioeconomic problems including an upsurge in HIV infection especially in the tropics. Patients and Methods. The study retrospectively reviewed all patients with Fournier’s gangrene managed in UMTH between January 2007 and December 2012. Results. Thirty-eight males aged 2 weeks to 80 years (mean 37.82) were reviewed, with most aged 30–39 years (13 (34.21%)). Clinical features were scrotal pain and swelling, 36 (94.74%), fever, 19 (50.00%), and discharging scrotal wound, 19 (50.00%). The predisposing conditions were UTI secondary to obstructive uropathy in 11 (28.95%), perianal suppuration, and HIV, in 8 (21.05%) patients each. Wound biopsy culture revealed mixed organisms in 27 (71.05%). Twenty-six (68.42%) had blood transfusions. Thirty-seven (97.37%) patients had wound debridement. Twenty (52.63%) had flap rotation for skin cover. There were 6 (15.79%) mortalities, of which 4 (10.53%) were HIV positive, 1 (2.63%) was diabetic, and 1 (2.63%) was both diabetic and HIV positive. Conclusion. Fournier’s gangrene is a fulminant synergistic necrotising fasciitis of the perineum and genitalia with poor prognosis especially when associated with HIV and diabetes, requiringprompt and aggressive management for good outcome. 1. Introduction Fournier’s gangrene is a rare and often fulminant necrotising fasciitis of the perineum and genital region frequently due to a synergistic polymicrobial infection [1]. The condition was first described as a disease of young adults of unknown cause by Fournier in 1888 [2]. The disease process affects all ages and has been reported in both sexes [3]. Some systemic illnesses are associated with Fournier’s gangrene. The most frequent of these are diabetes mellitus [4], HIV [5], and alcoholism [6]. Others are local conditions like perianal suppurations and urinary tract infection (UTI) complicating obstructive uropathy [7]. The study reviewed Fournier’s gangrene in relation to aetiology, presentation, management, and outcome. 2. Patients and Methods The study reviewed all patients managed for Fournier’s gangrene in UMTH over a 6-year period between January 2007 and December 2012. A written informed consent was obtained from all patients, and written permission was given by the hospital Medical and Ethical Committee. Data were extracted from clinical and laboratory information and analysed using SPSS version 16. The diagnosis of Fournier’s gangrene (Figures 1 and 2) was made on clinical assessment. Patients