[Synergistic necrotizing fasciitis of the anoperineal and external genitalia: progression to Fournier's gangrene?].
INTRODUCTION: In 1883, Fournier, a French venereal disease physician, described five patients with fulminant surgical infection of the male genitalia. He pointed to three main features: 1) sudden onset, 2) rapid gangrene progression, and 3) no visible cause. Since then, multiple primary causes have been identified such as genitourinary infections, local trauma, different surgical procedures or instruments, as well as acute anorectal disease (ischiorectal abscesses). We describe the experience with patients diagnosed with Fournier's Syndrome or necrotizing anoperineal and genital infection in our hospital service. MATERIAL AND METHODS: Medical files were reviewed from the Proctology Department of the IESS Regional Hospital from January 1, 1980, to May 15, 2004. The method was descriptive, retrospective, and longitudinal. RESULTS: Fifty-one predominantly male patients (48 males and 3 females) with a mean age of 49 years were studied. Symptoms were present for 8.7 days. The most common associated disease was diabetes mellitus (24 patients). Cultures were only used for anaerobes and mainly E. coli was identified. Extensive incisions, continuous debridement and necrotic tissue were included in the surgical procedure as many times as necessary. There was progression in the abdominal wall and the inguinal region. Orchidectomy and diversion colostomy were performed in 10 patients. Average hospital stay was 32 days. Antibiotic treatment was used against aerobes and anaerobes. Eight patients died (15.5%). CONCLUSIONS: In these patients, local resistance is disturbed and cell immunity is impaired. Also, the nutritional and vascular condition of patients is affected because of aerobe/anaerobe bacterial synergy. It is recommended to immediately start pus drainage, incise even hyperemic tissue, and debride and resect necrotized tissue several times to avoid residual infection and sepsis.