Management and Outcome of Fournier Gangrene in a Nigeria Hospital

Najeem Adedamola Idowu; Stephene Oluwatosin Ilori; Peter Olalekan Odeyemi; Stephene Ishola Adedokun

doi:10.64387/tjs.2025.272035

Authors

Najeem Adedamola Idowu Division of Urology, Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital Ogbomoso
Stephene Oluwatosin Ilori Department of Surgery, Plastic and Reconstructive Surgery Unit, Ladoke Akintola University of Technology Teaching Hospital Ogbomoso
Peter Olalekan Odeyemi Division of Urology, Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital Ogbomoso
Stephene Ishola Adedokun Division of Urology, Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital Ogbomoso

DOI:

https://doi.org/10.64387/tjs.2025.272035

Keywords:

Fournier gangrene, Management, Mortality

Abstract

Background: Fournier gangrene is a polymicrobial soft tissue infection of the genito-perineal region of the body. It is relatively rare but life-threatening.

Objective: This study aimed to discuss the management and outcome of Fournier gangrene.

Materials and Methods: The records of patients managed as cases of Fournier gangrene between 2020 and 2024 were retrieved from the hospital medical record department. The information collated from these files includes socio-demographic data, clinical features, modality, and treatment outcome. Descriptive analysis was done using SPSS version 23.

Results: Although 15 patients were admitted and managed as Fournier gangrene, only 13 patients had complete data and were analyzed. The age distribution was between 21-80 years, with a mean of 41.1 ± 15.7 SD. All the patients were male, and all of them presented in emergency with clinical features of sepsis identified in 3 patients. The wound culture of the remaining 7 patients (53.8%) could not be retrieved. The investigated subjects ' Fournier gangrene severity index (FGSI) score showed a range of 2-12 with a mean of 7.6 ± 3.1 SD. Concerning definitive wound care, six patients (46.2%) had spontaneous wound closure due to the relatively small size of the defect. Five patients (38.5%) had primary wound closure under spinal anesthesia. The remaining two patients with FGSI scores of 9 and 11 underwent reconstructive procedures: scrotal advancement flaps + gracilis muscle flap + split-thickness skin graft.

Conclusion: The average FGSI score was 7. There was no mortality. The most commonly involved part was the scrotum, while the rarest was the penis. Prompt response and adequate resuscitation are required for good outcomes, as observed in this study.

References

Gopi A, Vinoba S, Murthy NS, et al. Fournier's gangrene: a microbiological overview. J Evolution Med Dent Sci. 2016;5(1):41-5. doi: 10.14260/jemds/2016/10.

Rengan V, Duraisami V, Ravindra C, et al. A case of Meleney’s abdominal gangrene in Madras Medical College. Int Surg J. 2019;6(8):2963-5. doi: 10.18203/2349-2902.isj20193117.

Yanar H, Taviloglu K, Ertekin C, et al. Fournier's gangrene: risk factors and strategies for management. World J Surg. 2006;30(9):1750-4. doi: 10.1007/s00268-005-0777-3.

Ersay A, Yilmaz G, Akgun Y, et al. Factors affecting mortality of Fournier's gangrene: review of 70 patients. ANZ J Surg. 2007;77(1-2):43-8. doi: 10.1111/j.1445-2197.2006.03975.x.

Levenson RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics. 2008;28(2):519-28. doi: 10.1148/rg.282075048.

Corcoran AT, Smaldone MC, Gibbons EP, et al. Validation of the Fournier's gangrene severity index in a large contemporary series. J Urol. 2008;180(3):944-8. doi: 10.1016/j.juro.2008.05.021.

Sorensen MD, Krieger JN, Rivara FP, et al. Fournier's gangrene: management and mortality predictors in a population based study. J Urol. 2009;182(6):2742-7. doi: 10.1016/j.juro.2009.08.050.

Bowen D, Juliebø-Jones P, Somani B. Global outcomes and lessons learned in the management of Fournier’s gangrene from high-volume centres: findings from a literature review over the last two decades. World Journal of Urology. 2022;40(10):2399-410.

Oyelowo N, Ahmed M, Lawal AT, et al. Fournier's gangrene: Presentation and predictors of mortality in Zaria, Nigeria. Ann Afr Med. 2021;20(2):105-10. doi: 10.4103/aam.aam_23_20.

Victor A, Francis GI. Fournier’s Gangrene Post Circumcision in a Tertiary Hospital in Southern Nigeria. Eur J Health Sci. 2022;7(5):28–38. doi: 10.47672/ejhs.1224.

Gürdal M, Yücebas E, Tekin A, et al. Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases. Urol Int. 2003;70(4):286-90. doi: 10.1159/000070137.

Lin WT, Chao CM, Lin HL, et al. Emergence of antibiotic-resistant bacteria in patients with Fournier gangrene. Surg Infect (Larchmt). 2015;16(2):165-8. doi: 10.1089/sur.2013.118.

Marín AG, Fuentes FT, Ayuso MC, et al. Predictive Factors for Mortality in Fournier's Gangrene: A Series of 59 Cases. Cir Esp (English Edition). 2015;93(1): 12-7. doi: 10.1016/j.cireng.2014.03.013.

Yeniyol CO, Suelozgen T, Arslan M, et al. Fournier's gangrene: experience with 25 patients and use of Fournier's gangrene severity index score. Urology. 2004;64(2):218-22. doi: 10.1016/j.urology.2004.03.049.

Villanueva-Sáenz E, Martínez Hernández-Magro P, Valdés Ovalle M, et al. Experience in management of Fournier's gangrene. Tech Coloproctol. 2002;6(1):5-13. doi: 10.1007/s101510200001.

Ilori OS, Onilede DA, Popoola AA. et al. Scrotal reconstruction with pedicled gracilis muscle flap following Fournier’s gangrene: a case report and literature review. Afr J Urol. 2021;27:165. doi: 10.1186/s12301-021-00268-1.