International Journal of Gerontology
Volume 2, Issue 2 , Pages 48-54, June 2008

Fournier's Gangrene in Elderly Patients

  • Ssu-Ming Huang

      Affiliations

    • Division of Colon and Rectal Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taipei, Taiwan
  • ,
  • Hsien Hsu

      Affiliations

    • Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Hsi-Hsien Hsu, Division of Colon and Rectal Surgery, Department of Surgery, Mackay Memorial Hospital, 92, Section 2, Chung-San North Road, Taipei, Taiwan

Accepted 15 March 2008.

Article Outline

Summary 

The population of elderly individuals is growing at an accelerating rate in Taiwan, similar to other industrialized countries in the world. More elderly people are being treated in hospital. The clinical characteristics of Fournier's gangrene in the elderly (atypical symptoms) differ substantially compared with younger patients (typical symptoms), and the severity is strongly associated with increased age and age-related comorbidities. Underlying comorbid conditions have to be treated concurrently for overall effective management. Early recognition and prompt management are crucial for elderly patients succumbing to Fournier's gangrene. Surgical debridement has remained the cornerstone of treatment in current clinical practice.

Key Words:  aging , necrotizing fasciitis

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Fournier JA . Gangrene foudroyante de la verge . Med Prat . 1883;4:589–596
  2. Smith GL , Bunker CB , Dinneen MD . Fournier's gangrene . Br J Urol . 1998;81:347–355
  3. Spirnak JP , Resnick MI , Hampel N , Persky L . Fournier's gangrene: report of 20 patients . J Urol . 1984;131:289–291
  4. Clayton MD , Fowler JE , Sharifi R , Pearl RK . Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia . Surg Gynecol Obstet . 1990;170:49–55
  5. Stephens BJ , Lathrop JC , Rice WT , Gruenberg JC . Fournier's gangrene: historic (1764–1978) versus contemporary (1979–1988) differences in etiology and clinical importance . Am Surg . 1993;59:149–154
  6. Flanigan RC , Kursh ED , McDougal WS , Persky L . Synergistic gangrene of the scrotum and penis secondary to colorectal disease . J Urol . 1978;119:369–371
  7. Laor E , Palmer LS , Tolia BM , Reid RE , Winter HI . Outcome prediction in patients with Fournier's gangrene . J Urol . 1995;154:89–92
  8. McHenry CR , Piotrowski JJ , Petrinic D , Malangoni MA . Determinants of mortality for necrotizing soft-tissue infections . Ann Surg . 1995;221:558–563 discussion 563–5.
  9. Elliott D , Kufera JA , Myers RA . The microbiology of necrotizing soft tissue infections . Am J Surg . 2000;179:361–366
  10. Korhonen K , Hirn M , Niinikoski J . Hyperbaric oxygen in the treatment of Fournier's gangrene . Eur J Surg . 1998;164:251–255
  11. Eke N . Fournier's gangrene: a review of 1726 cases . Br J Surg . 2000;87:718–728
  12. Hollabaugh RS , Dmochowski RR , Hickerson WL , Cox CE . Fournier's gangrene: therapeutic impact of hyperbaric oxygen . Plast Reconstr Surg . 1998;101:94–100
  13. Korhonen K . Hyperbaric oxygen therapy in acute necrotizing infections. With a special reference to the effects on tissue gas tensions . Ann Chir Gynaecol . 2000;89(Suppl 214):7–36
  14. Olsofka JN , Carrillo EH , Spain DA , Polk HC . The continuing challenge of Fournier's gangrene in the 1990s . Am Surg . 1999;65:1156–1159
  15. Yaghan RJ , Al-Jaberi TM , Bani-Hani I . Fournier's gangrene: changing face of the disease . Dis Colon Rectum . 2000;43:1300–1308
  16. Baolu M , Gül O , Yildirgan I , Balik AA , Ozbey I , Oren D . Fournier's gangrene: review of fifteen cases . Am Surg . 1997;63:1019–1021
  17. Hejase MJ , Simonin JE , Bihrle R , Coogan CL . Genital Fournier's gangrene: experience with 38 patients . Urology . 1996;47:734–739
  18. Benizri E , Fabiani P , Migliori G , Chevallier D , Peyrottes A , Raucoules M , et al.   Gangrene of the perineum . Urology . 1996;47:935–939
  19. Baskin LS , Carroll PR , Cattolica EV , McAninch JW . Necrotising soft tissue infections of the perineum and genitalia. Bacteriology, treatment and risk assessment . Br J Urol . 1990;65:524–529
  20. Ahrenholz DH . Necrotizing soft-tissue infections . Surg Clin North Am . 1988;68:199–214
  21. Scott SD , Dawes RF , Tate JJ , Royle GT , Karran SJ . The practical management of Fournier's gangrene . Ann R Coll Surg Engl . 1988;70:16–20
  22. Gerber GS , Guss SP , Pielet RW . Fournier's gangrene secondary to intra-abdominal processes . Urology . 1994;44:779–782
  23. Gamagami RA , Mostafavi M , Gamagami A , Lazorthes F . Fournier's gangrene: an unusual presentation for rectal carcinoma . Am J Gastroenterol . 1998;93:657–658
  24. Gould SW , Banwell P , Glazer G . Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene . Eur J Surg Oncol . 1997;23:367–368
  25. Brings HA , Matthews R , Brinkman J , Rotolo J . Crohn's disease presenting with Fournier's gangrene and enterovesical fistula . Am Surg . 1997;63:401–405
  26. Jiang T , Covington JA , Haile CA , Murphy JB , Rotolo FS , Lake AM . Fournier gangrene associated with Crohn disease . Mayo Clin Proc . 2000;75:647–649
  27. Ong HS , Ho YH . Genitoperineal gangrene: experience in Singapore . Aust NZ J Surg . 1996;66:291–293
  28. Rajbhandari SM , Wilson RM . Unusual infections in diabetes . Diabetes Res Clin Pract . 1998;39:123–128
  29. Efem SE . The features and aetiology of Fournier's gangrene . Postgrad Med J . 1994;70:568–571
  30. Tripathi FM , Khanna NN , Venkateshwarlu V , Sinha JK . Gangrene of the scrotum: a series of 20 cases . Br J Plast Surg . 1978;31:242–243
  31. Chen DY . Updated therapy in elderly patients with knee osteoarthritis . Int J Gerontol . 2007;1:31–39
  32. Martin GS , Mannino DM , Eaton S , Moss M . The epidemiology of sepsis in the United States from 1979 through 2000 . N Engl J Med . 2003;348:1546–1554
  33. Franceschi C , Monti D , Sansoni P , Cossarizza A . The immunology of exceptional individuals: the lesson of centenarians . Immunol Today . 1995;16:12–16
  34. Jarrett PG , Rockwood K , Carver D , Stolee P , Cosway S . Illness presentation in elderly patients . Arch Intern Med . 1995;155:1060–1064
  35. Jones RB , Hirschmann JV , Brown GS , Tremann JA . Fournier's syndrome: necrotizing subcutaneous infection of the male genitalia . J Urol . 1979;122:279–282
  36. Sutherland ME , Meyer AA . Necrotizing soft-tissue infections . Surg Clin North Am . 1994;74:591–607
  37. Porru D , Pasquale Chessa P . Fournier's disease. Report of a case and review of the literature . Arch Esp Urol . 1991;44:1029–1032
  38. Wolach MD , MacDermott JP , Stone AR , deVere White RW . Treatment and complications of Fournier's gangrene . Br J Urol . 1989;64:310–314
  39. Ledingham IM , Tehrani MA . Diagnosis, clinical course and treatment of acute dermal gangrene . Br J Surg . 1975;62:364–372
  40. Di Falco G , Guccione C , D'Annibale A , Ronsisvalle S , Lavezzo P , Fregonese D , et al.   Fournier's gangrene following a perianal abscess . Dis Colon Rectum . 1986;29:582–585
  41. Okizuka H , Sugimura K , Yoshizako T . Fournier's gangrene: diagnosis based on MR findings . AJR Am J Roentgenol . 1992;158:1173–1174
  42. Amendola MA , Casillas J , Joseph R , Antun R , Galindez O . Fournier's gangrene: CT findings . Abdom Imaging . 1994;19:471–474
  43. Laucks SS . Fournier's gangrene . Surg Clin North Am . 1994;74:1339–1352
  44. Biyani CS , Mayor PE , Powell CS . Case report: Fournier's gangrene: roentgenographic and sonographic findings . Clin Radiol . 1995;50:728–729
  45. Dogra VS , Smeltzer JS , Poblette J . Sonographic diagnosis of Fournier's gangrene . J Clin Ultrasound . 1994;22:571–572
  46. Kane CJ , Nash P , McAninch JW . Ultrasonographic appearance of necrotizing gangrene: aid in early diagnosis . Urology . 1996;48:142–144
  47. Miller JD . The importance of early diagnosis and surgical treatment of necrotizing fasciitis . Surg Gynecol Obstet . 1983;157:197–200
  48. Larcan A , Laprevote-Heully MC , Lambert H , Mantz JM , Tempe JD , Sauder P , et al.   Les gangrènes gazeuses périnéales . In: Les Anaérobies, Microbiologie, Pathologie . Paris: Masson; 1981;p. 232–242
  49. Paty R , Smith AD . Gangrene and Fournier's gangrene . Urol Clin North Am . 1992;19:149–162
  50. Kaiser RE , Cerra FB . Progressive necrotizing surgical infections: a unified approach . J Trauma . 1981;21:349–355
  51. Caird J , Abbasakoor F , Quill R . Necrotising fasciitis in a HIV positive male: an unusual indication for abdominoperineal resection . Ir J Med Sci . 1999;168:251–253
  52. Palmer LS , Winter HI , Tolia BM , Reid RE , Laor E . The limited impact of involved surface area and surgical debridement on survival in Fournier's gangrene . Br J Urol . 1995;76:208–212
  53. Capelli-Schellpfeffer M , Gerber GS . The use of hyperbaric oxygen in urology . J Urol . 1999;162:647–654
  54. Bubrick MP , Hitchcock CR . Necrotizing anorectal and perineal infections . Surgery . 1979;86:655–662
  55. Salvino C , Harford FJ , Dobrin PB . Necrotizing infections of the perineum . South Med J . 1993;86:908–911
  56. Frezza EE , Atlas I . Minimal debridement in the treatment of Fournier's gangrene . Am Surg . 1999;65:1031–1034
  57. Shupak A , Shoshani O , Goldenberg I , Barzilai A , Moskuna R , Bursztein S . Necrotizing fasciitis: an indication for hyperbaric oxygenation therapy? . Surgery . 1995;118:873–878
  58. Berg A , Armitage JO , Burns CP . Fournier's gangrene complicating aggressive therapy for hematologic malignancy . Cancer . 1986;57:2291–2294
  59. Martinelli G , Alessandrino EP , Bernasconi P , Caldera D , Colombo A , Malcovati L , et al.   Fournier's gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation . Bone Marrow Transplant . 1998;22:1023–1026
  60. Elem B , Ranjan P . Impact of immunodeficiency virus (HIV) on Fournier's gangrene: observations in Zambia . Ann R Coll Surg Engl . 1995;77:283–286
  61. Oh C , Lee C , Jacobson JH . Necrotizing fasciitis of perineum . Surgery . 1982;91:49–51
  62. Enriquez JM , Moreno S , Devesa M , Morales V , Platas A , Vicente E . Fournier's syndrome of urogenital and anorectal origin. A retrospective, comparative study . Dis Colon Rectum . 1987;30:33–37
  63. Darke SG , King AM , Slack WK . Gas gangrene and related infection: classification, clinical features and aetiology, management and mortality. A report of 88 cases . Br J Surg . 1977;64:104–112

PII: S1873-9598(08)70010-3

doi:10.1016/S1873-9598(08)70010-3

International Journal of Gerontology
Volume 2, Issue 2 , Pages 48-54, June 2008