Fournier gangreninde tek merkez deneyimi: 23 olguluk retrospektif analiz

Abstract

Amaç: Fournier gangreni tanısı ile kliniğimizde takip ve tedavi edilen hastaların sonuçlarını retrospektif olarak irdelemeyi ve literatüre sunmayı amaçladık. Gereç ve yöntem: Kliniğimizde Ekim 2015-Ekim 2024 tarihleri arasında tedavi görmüş olan Fournier gangreni tanılı 23 hastanın bilgileri retrospektif olarak incelendi. Hastaların yaş, cinsiyet, gangrenin yerleşim lokalizasyonu, mortalite durumu, ek hastalıkları, laboratuvar değerleri, tedavi yöntemleri ve mikrobiyolojik sonuçları analiz edildi. Bulgular: Yirmi üç hastanın 18 (%78,3)’i erkek 5 (%21,7)’i kadın olmak üzere ortalama yaşları 56,1 (26-78) olarak saptandı. Hastaların şikayeti başladıktan itibaren hastaneye başvuru süreleri ortalama 7,95±4,67 gündü. Hastaların ortalama hastanede kalış süreleri 16,2 (2-35) gün olup, 11 (%47) hastanın yoğun bakım ihtiyacı oldu. Serimizde 4 (%17,4) hasta hayatını kaybetti. 23 hastanın 17 (%74) sinde ek hastalık mevcuttu 6 (%26) sında ise hiçbir ek hastalık yoktu. Hastaların 9 (%52,9)’unda hipertansiyon (HT), 9 (%52,9)’unda diabetes mellitus mevcuttu. Hastaların C-reaktif protein seviyeleri ortalama 203,3 mg/L olarak saptandı. Fournier gangreninin ağırlıklı olarak görüldüğü yerler ise 9 (%39,13) hastada perianal, 8 (%34,79) hastada perineal ve 3 (%13,04) hastada skrotal bölgelerdi. Hastalar mikrobiyolojik açıdan incelendiğinde polimikrobiyal flora dikkati çekmiştir ve Eschericia coli %30,4 ile en sık görülen etken olmuştur. Hastaların tamamına cerrahi debridman yapıldı ve antibiyoterapileri düzenlenerek takip edildi. Hastalara düzenli olarak lokal yara bakımı uygulandı. Hastaların 14 (%60,8)’ine kolostomi açıldı, 6 (%26,8)’sına ise vakum yardımlı kapama (VAK) tedavisi uygulandı. Sonuç: Fournier gangreni sinsi bir şekilde hızla ilerleyen erken tanı konulup tedavi edilmediğinde mortal seyredebilen enfeksiyöz bir hastalıktır. Tedavi programında başrı elde edebimek için multidisipliner bir yaklaşım şarttır.

Keywords

• Fournier Gangreni
• kolostomi
• VAK

Fournier's gangrene in a single-center experience: a retrospective analysis of 23 cases

Abstract

Purpose: This study aims to retrospectively evaluate the outcomes of patients diagnosed with Fournier’s gangrene (FG) treated and followed up in our clinic and to contribute to the literature. Materials and methods: We retrospectively analyzed the data of 23 patients diagnosed with Fournier's gangrene and treated in our clinic between October 2015 and October 2024. Parameters such as age, gender, localization of gangrene, mortality status, comorbidities, laboratory findings, treatment methods, and microbiological results were evaluated. Results: Of the 23 patients, 18 (78.3%) were male, and 5 (21.7%) were female, with a mean age of 56.1 years (range: 26-78). The average time from symptom onset to hospital presentation was 7.95±4.67 days. The average hospital stay was 16.2 days (range: 2-35), and 11 (47%) patients required intensive care. Mortality occurred in 4 (17.4%) patients. Comorbidities were present in 17 (74%) patients, while 6 (26%) had no comorbid conditions. Hypertension (HT) and diabetes mellitus (DM) were the most common comorbidities, each seen in 9 (52.9%) patients. The mean C-reactive protein (CRP) level was 203.3 mg/L. Gangrene was predominantly observed in the perianal region in 9 (39.13%) patients, the perineal region in 8 (34.79%) patients, and the scrotal region in 3 (13.04%) patients. Microbiological analysis revealed polymicrobial flora, with Escherichia coli being the most common pathogen (30.4%). All patients underwent surgical debridement and were treated with appropriate antibiotic therapy and regular wound care. Colostomy was performed in 14 (60.8%) patients, while vacuum-assisted closure (VAC) therapy was applied to 6 (26.8%). Conclusion: Fournier's gangrene is a rapidly progressing and potentially fatal infectious disease if not diagnosed and treated promptly. A multidisciplinary approach is essential to achieving successful outcomes in its management.

Keywords

• Fournier's Gangrene
• colostomy
• VAC

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