Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify pa...Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.展开更多
BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated w...BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.展开更多
BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral sten...BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral stent implantation,minor complications such as urinary tract infection,irritative symptoms,gross hematuria,and urethral pain have been observed;however,there are no reports of life-threatening events.Herein,we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia(volume,126 ccs;as measured by transrectal ultrasound)had undergone insertion of a thermoexpandable urethral stent(Memokath 028)as he was unfit for surgery under general anesthesia.However,the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent(Memokath 028).We had planned to remove the Memokath 028;however,the patient was lost to follow-up.The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area.In digital rectal examination,tenderness and heat of prostate was identified.Also,the black skin color change with foulsmelling from right scrotum to right inguinal area was identified.In computed tomography finding,subcutaneous emphysema was identified to same area.He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings.In emergency room,Fournier’s gangrene severity index value is seven points.Therefore,he underwent emergent extended surgical debridement and removal of the Memokath 028.Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed.However,the patient died 14 days after surgery due to multiorgan failure.CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients,its rapid removal may help prevent severe complications.展开更多
Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following...Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.展开更多
BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of ...BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.展开更多
Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The m...Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The mainstay of treatment is swift open drainage and early aggressive surgical debridement of all necrotic tissue, followed by targeted antibiotic therapy. The authors report on two patients who were admitted to the surgical ward. Both presented with initial perianal sepsis complicated by painful swollen scrotum with rapid progression of gangrene of the scrotal skin and subcutaneous tissue, extensive cellulitis of the perineum, and in one patient crepitation of the anterior abdominal wall. A diagnosis of Fournier’s Gangrene was made and they were both managed by prompt resuscitation, broad-spectrum antibiotics, extensive debridement of all necrotic tissue in theatre, daily wound dressing, and repeated neurectomy on the ward. One of the patients had a colostomy done and the other a cystostomy to divert feces and relieve chronic urinary retention respectively. These patients were successfully treated despite the severity of their conditions which was complicated by severe sepsis in the face of limited diagnostic capabilities and resources, using a multidisciplinary approach and basic clinical monitoring as a guide.展开更多
Fournier’s gangrene described in 1883 by Jean Alfred Fournier, still poses ethiopathogenic, evolutive and therapeutic problems. This is a therapeutic emergency;early diagnosis, medical and surgical treatments contrib...Fournier’s gangrene described in 1883 by Jean Alfred Fournier, still poses ethiopathogenic, evolutive and therapeutic problems. This is a therapeutic emergency;early diagnosis, medical and surgical treatments contribute to reducing mortality rate. Tissue defect engendered by infection and/or by its excision requires morphological and functional reconstruction. The choice of the reconstruction technique depends on several parameters: early or delayed coverage, the size of the defect, the local capital skin and the patient’s general condition. Through this study involving 95 cases of scrotal and perineal gangrene treated at the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca over a period of 10 years (2004-2014), we report our approach in the surgical management of defect secondary to Fournier’s gangrene.展开更多
<strong>Introduction:</strong> Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortalit...<strong>Introduction:</strong> Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortality remains high despite advances in resuscitation. We report the experience of the surgery department of the Regional University Hospital Center (CHUR) of Ouahigouya in order to describe the epidemiological profile and the therapeutic aspects of GOGE. <strong>Patients and</strong> <strong>methods:</strong> We carried out a descriptive and analytical retrospective study collecting 41 cases of Fournier’s gangrene treated over 63 months (from March 2013 to July 2018) in the surgical department of the Ouahigouya regional university hospital center. Ethical clearance was taken from the institutional ethics committee. <strong>Results:</strong> The mean age of the patients was 65.02 ± 17.92 years with extremes of 23 years and 95 years. All patients were male. Urologic causes were the most common with 36.58% of cases. The average consultation time was 15.44 ± 16.04 days with extremes of 1 day and 60 days. All patients received resuscitation, bi or triantibiotherapy and surgical debridement. The mortality rate was 24.39%. The mean duration of hospitalization was 10.83 ± 6.257 days with extremes of 1 day and 60 days. <strong>Conclusion:</strong> The Fournier’s gangrene always has a very high lethality. Improving the prognosis requires fast and effective management.展开更多
Background Fournier’s gangrene(FG)is a rare life-threatening form of necrotizing fasciitis.The risk factors for septic shock in patients with FG are unclear.This study aimed to identify potential risk factors and dev...Background Fournier’s gangrene(FG)is a rare life-threatening form of necrotizing fasciitis.The risk factors for septic shock in patients with FG are unclear.This study aimed to identify potential risk factors and develop a prediction model for septic shock in patients with FG.Methods This retrospective cohort study included patients who were treated for FG between May 2013 and May 2020 at the Sixth Affiliated Hospital,Sun Yat-sen University(Guangzhou,China).The patients were divided into a septic shock group and a non-septic shock group.An L1-penalized logistic regression model was used to detect the main effect of important factors and a penalized Quadratic Discriminant Analysis method was used to identify possible interaction effects between different factors.The selected main factors and interactions were used to obtain a logistic regression model based on the Bayesian information criterion.Results A total of 113 patients with FG were enrolled and allocated to the septic shock group(n=24)or non-septic shock group(n=89).The best model selected identified by backward logistic regression based on Bayesian information criterion selected temperature,platelets,total bilirubin(TBIL)level,and pneumatosis on pelvic computed tomography/magnetic resonance images as the main linear effect and Na^(+)×TBIL as the interaction effect.The area under the ROC curve of the probability of FG with septic shock by our model was 0.84(95%confidence interval,0.78–0.95).The Harrell’s concordance index for the nomogramwas 0.864(95%confidence interval,0.78–0.95).Conclusion We have developed a prediction model for evaluation of the risk of septic shock in patients with FG that could assist clinicians in identifying critically ill patients with FG and prevent them from reaching a crisis state.展开更多
Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,e...Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.展开更多
<span style="font-family:Verdana;">Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. </span><b><b><span sty...<span style="font-family:Verdana;">Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. </span><b><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> We report the experience of the service in the management of Fournier gangrene of the external genital organs by inguinal flap pediculated in front of the loss of significant substances of the scrotum.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">Patients and method: This was a mono-centric retrospective study from January 2008 to August 2021 in the General Surgery Department of the Bocar Sidi Sall University Hospital (CHU BSS) in Kati. It focused on patients treated for Fournier gangrene of external genitals.</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The variables studied were age, sex, blood count, germs encountered, the antibiogram, duration of evolution, reconstruction of the scrotum by pedicle flap, and morbidity. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">During the study period we collected 5 cases of Fournier gangrene of external genitals in the service. The average age was 57.6 years and all the patients were male. The average duration of evolution was 5 days for an average age of 57.6 years. All patients were male. <i></i></span><i><i><span style="font-family:Verdana;">Echerichia coli</span></i><span style="font-family:Verdana;"></span></i> (<i><i><span style="font-family:Verdana;">E.</span></i><i><span style="font-family:;" "=""> </span></i><i><span style="font-family:Verdana;">coli</span></i><span style="font-family:Verdana;"></span></i>)<span> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">was the frequently observed germ followed by <i></i></span><i><i><span style="font-family:Verdana;">Enterobacter fécalis</span></i><span style="font-family:Verdana;"></span></i> (<i></i></span><i><i><span style="font-family:Verdana;">E. fecalis</span></i><span style="font-family:Verdana;"></span></i>).<span style="font-family:;" "=""> </span><span style="font-family:Verdana;">They were resistant to the usual antibiotics. The germs were 100% sensitive to imipenem</span><span style="font-family:Verdana;">e</span><span style="font-family:Verdana;"> and nitrofurantoin, 70% to gentamycin. The wide necrosectomy followed 3 weeks later by the inguinal flap pedicular plasty greatly improved the surgical procedures. Conclusion: Fournier’s syndrome is a medical surgical emergency whose prognosis is strongly related to early management.</span>展开更多
文摘Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.
文摘BACKGROUND Fournier gangrene is a rare,life-threatening infection characterized by necrotizing fasciitis in the perineal,genital and/or lower abdominal regions.Despite its rarity,the unfavorable prognosis associated with this disease is dependent on the timing of medical care.CASE SUMMARY A 3-month-old boy was admitted to our pediatric intensive care unit in critical condition after a 5-day history of fever and scrotal erythema with breaching skin lesions and swelling.Despite ambulatory antibiotic treatment,the child’s clinical condition deteriorated.At the time of admission,the child had necrotizing scrotal fasciitis that had spread to the abdomen.Following reanimation,the surgeon decided on an immediate intervention to rule out testicular torsion and to debride the affected area.Despite optimal antibiotic and supportive therapy,the patient developed severe sepsis with liver dysfunction,making treatment more challenging.CONCLUSION Recognizing Fournier gangrene,prompt referral to pediatric surgery,and appropriate antibiotic coverage are critical for avoiding sepsis and multiorgan dysfunction.
基金Supported by the 2021 Yeungnam University Research Grant.
文摘BACKGROUND Thermo-expandable urethral stent(Memokath 028)implantation is an alternative treatment for older patients with lower urinary tract symptoms and benign prostatic obstruction.Following prostatic urethral stent implantation,minor complications such as urinary tract infection,irritative symptoms,gross hematuria,and urethral pain have been observed;however,there are no reports of life-threatening events.Herein,we report a critical case of Fournier’s gangrene that occurred 7 years after prostatic stenting.CASE SUMMARY An 81-years-old man with benign prostatic hyperplasia(volume,126 ccs;as measured by transrectal ultrasound)had undergone insertion of a thermoexpandable urethral stent(Memokath 028)as he was unfit for surgery under general anesthesia.However,the patient had undergone a suprapubic cystostomy for recurrent acute urinary retention 4 years after the insertion of prostatic stent(Memokath 028).We had planned to remove the Memokath 028;however,the patient was lost to follow-up.The patient presented to the emergency department 3 years after the suprapubic cystostomy with necrotic changes from the right scrotum to the right inguinal area.In digital rectal examination,tenderness and heat of prostate was identified.Also,the black skin color change with foulsmelling from right scrotum to right inguinal area was identified.In computed tomography finding,subcutaneous emphysema was identified to same area.He was diagnosed with Fournier’s gangrene based on the physical examination and computed tomography findings.In emergency room,Fournier’s gangrene severity index value is seven points.Therefore,he underwent emergent extended surgical debridement and removal of the Memokath 028.Broad-spectrum intravenous antibiotics were administered and additional necrotic tissue debridement was performed.However,the patient died 14 days after surgery due to multiorgan failure.CONCLUSION If Memokath 028 for benign prostatic hyperplasia is not working in older patients,its rapid removal may help prevent severe complications.
文摘Fournier’s gangrene is a form of necrotizing fasciitis that has multiple causes and is relatively uncommon in children. We report a case of Fournier’s gangrene of infectious origin in a 12-month-old infant following an insect bite. A rapid diagnosis and multidisciplinary care saved the patient.
文摘BACKGROUND Fournier's gangrene(FG)is a serious,aggressive and often deadly polymicrobial infection of the soft tissues of the perineum,the rectum and the external genital organs.It is an anatomical subcategory of necrotizing fasciitis,which has a similar etiology and treatment strategy.CASE SUMMARY A 60-year-old man was admitted to the hospital during severe acute respiratory syndrome coronavirus 2 pandemic with complaints of fever up to 38.9°C,abdominal pain,and edema of the scrotum,the penis,the perineum,and the right gluteal region for 2 d.Computed tomography of the abdomen and the pelvis revealed extensive inflammatory infiltrations of the subcutaneous tissue of the hypogastrium,and the penis;along with liquefaction and presence of gas in the subcutaneous tissues of the scrotum,the perineum,and the right gluteal region.The patient was diagnosed with FG,and was urgently qualified to undergo surgery in the Department of Urology.After performing the necessary examinations,a resection of the necrotic tissues with bilateral orchiectomy and excision of the penile and scrotal skin was performed.After surgery,he was transferred to the intensive care unit for further management.CONCLUSION Early management prevents the resection of the other organs by inhibiting the contiguous spread of infection.
文摘Fournier’s Gangrene is a formidable rare disease characterized by high mortality rates despite optimal medical and surgical management. It is an acute surgical emergency and requires a high degree of suspicion. The mainstay of treatment is swift open drainage and early aggressive surgical debridement of all necrotic tissue, followed by targeted antibiotic therapy. The authors report on two patients who were admitted to the surgical ward. Both presented with initial perianal sepsis complicated by painful swollen scrotum with rapid progression of gangrene of the scrotal skin and subcutaneous tissue, extensive cellulitis of the perineum, and in one patient crepitation of the anterior abdominal wall. A diagnosis of Fournier’s Gangrene was made and they were both managed by prompt resuscitation, broad-spectrum antibiotics, extensive debridement of all necrotic tissue in theatre, daily wound dressing, and repeated neurectomy on the ward. One of the patients had a colostomy done and the other a cystostomy to divert feces and relieve chronic urinary retention respectively. These patients were successfully treated despite the severity of their conditions which was complicated by severe sepsis in the face of limited diagnostic capabilities and resources, using a multidisciplinary approach and basic clinical monitoring as a guide.
文摘Fournier’s gangrene described in 1883 by Jean Alfred Fournier, still poses ethiopathogenic, evolutive and therapeutic problems. This is a therapeutic emergency;early diagnosis, medical and surgical treatments contribute to reducing mortality rate. Tissue defect engendered by infection and/or by its excision requires morphological and functional reconstruction. The choice of the reconstruction technique depends on several parameters: early or delayed coverage, the size of the defect, the local capital skin and the patient’s general condition. Through this study involving 95 cases of scrotal and perineal gangrene treated at the National Center of Burns and Plastic Surgery of Ibn Rochd University Hospital of Casablanca over a period of 10 years (2004-2014), we report our approach in the surgical management of defect secondary to Fournier’s gangrene.
文摘<strong>Introduction:</strong> Gangrene of extern genitary organs is a rapidly progressive necrotizing fasciitis of the perineum and external genitalia that results from a polymicrobial infection. Mortality remains high despite advances in resuscitation. We report the experience of the surgery department of the Regional University Hospital Center (CHUR) of Ouahigouya in order to describe the epidemiological profile and the therapeutic aspects of GOGE. <strong>Patients and</strong> <strong>methods:</strong> We carried out a descriptive and analytical retrospective study collecting 41 cases of Fournier’s gangrene treated over 63 months (from March 2013 to July 2018) in the surgical department of the Ouahigouya regional university hospital center. Ethical clearance was taken from the institutional ethics committee. <strong>Results:</strong> The mean age of the patients was 65.02 ± 17.92 years with extremes of 23 years and 95 years. All patients were male. Urologic causes were the most common with 36.58% of cases. The average consultation time was 15.44 ± 16.04 days with extremes of 1 day and 60 days. All patients received resuscitation, bi or triantibiotherapy and surgical debridement. The mortality rate was 24.39%. The mean duration of hospitalization was 10.83 ± 6.257 days with extremes of 1 day and 60 days. <strong>Conclusion:</strong> The Fournier’s gangrene always has a very high lethality. Improving the prognosis requires fast and effective management.
文摘Background Fournier’s gangrene(FG)is a rare life-threatening form of necrotizing fasciitis.The risk factors for septic shock in patients with FG are unclear.This study aimed to identify potential risk factors and develop a prediction model for septic shock in patients with FG.Methods This retrospective cohort study included patients who were treated for FG between May 2013 and May 2020 at the Sixth Affiliated Hospital,Sun Yat-sen University(Guangzhou,China).The patients were divided into a septic shock group and a non-septic shock group.An L1-penalized logistic regression model was used to detect the main effect of important factors and a penalized Quadratic Discriminant Analysis method was used to identify possible interaction effects between different factors.The selected main factors and interactions were used to obtain a logistic regression model based on the Bayesian information criterion.Results A total of 113 patients with FG were enrolled and allocated to the septic shock group(n=24)or non-septic shock group(n=89).The best model selected identified by backward logistic regression based on Bayesian information criterion selected temperature,platelets,total bilirubin(TBIL)level,and pneumatosis on pelvic computed tomography/magnetic resonance images as the main linear effect and Na^(+)×TBIL as the interaction effect.The area under the ROC curve of the probability of FG with septic shock by our model was 0.84(95%confidence interval,0.78–0.95).The Harrell’s concordance index for the nomogramwas 0.864(95%confidence interval,0.78–0.95).Conclusion We have developed a prediction model for evaluation of the risk of septic shock in patients with FG that could assist clinicians in identifying critically ill patients with FG and prevent them from reaching a crisis state.
文摘Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.
文摘<span style="font-family:Verdana;">Fournier’s syndrome is a poly microbial necrotizing fasciitis, of severe evolution of the perineum and external genitals. </span><b><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"></span></b><span style="font-family:Verdana;"> We report the experience of the service in the management of Fournier gangrene of the external genital organs by inguinal flap pediculated in front of the loss of significant substances of the scrotum.</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">Patients and method: This was a mono-centric retrospective study from January 2008 to August 2021 in the General Surgery Department of the Bocar Sidi Sall University Hospital (CHU BSS) in Kati. It focused on patients treated for Fournier gangrene of external genitals.</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">The variables studied were age, sex, blood count, germs encountered, the antibiogram, duration of evolution, reconstruction of the scrotum by pedicle flap, and morbidity. <b></b></span><b><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"></span></b></span><b> </b><span style="font-family:Verdana;">During the study period we collected 5 cases of Fournier gangrene of external genitals in the service. The average age was 57.6 years and all the patients were male. The average duration of evolution was 5 days for an average age of 57.6 years. All patients were male. <i></i></span><i><i><span style="font-family:Verdana;">Echerichia coli</span></i><span style="font-family:Verdana;"></span></i> (<i><i><span style="font-family:Verdana;">E.</span></i><i><span style="font-family:;" "=""> </span></i><i><span style="font-family:Verdana;">coli</span></i><span style="font-family:Verdana;"></span></i>)<span> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">was the frequently observed germ followed by <i></i></span><i><i><span style="font-family:Verdana;">Enterobacter fécalis</span></i><span style="font-family:Verdana;"></span></i> (<i></i></span><i><i><span style="font-family:Verdana;">E. fecalis</span></i><span style="font-family:Verdana;"></span></i>).<span style="font-family:;" "=""> </span><span style="font-family:Verdana;">They were resistant to the usual antibiotics. The germs were 100% sensitive to imipenem</span><span style="font-family:Verdana;">e</span><span style="font-family:Verdana;"> and nitrofurantoin, 70% to gentamycin. The wide necrosectomy followed 3 weeks later by the inguinal flap pedicular plasty greatly improved the surgical procedures. Conclusion: Fournier’s syndrome is a medical surgical emergency whose prognosis is strongly related to early management.</span>
基金supported by the National Key Clinical Discipline Medical Scientific Research Foundation of Guangdong Province,China(Grant number A2015180)the National Natural Science Foundation of China(Grant number 81603628)Sun Yat-Sen University Clinical Research 5010 Program(Grant number 2017017).
