Fournier’s Gangrene following coronary artery bypass surgery: Should extracorporeal circulation be blamed?

Year 2015, , 81 - 85, 01.07.2015

Sefer Usta Hamit Serdar Basbug

https://doi.org/10.5455/umj.20150827014934

Abstract

Background: Fournier’s gangrene is a rare infection with high morbidity and mortality caused by the aerobic and anaerobic bacteria that affects the superficial tissues. It is a kind of necrotizing infection which is characterized by the necrotizing forms of cellulitis, myositis, and fasciitis. These infections are presented clinically by fulminant tissue destruction, systemic signs of toxicity, and even sepsis. Accurate diagnosis and appropriate treatment must include early surgical intervention and antibiotic therapy. Aggressive debridement, appropriate broad-spectrum antibiotic therapy, and combined enteral and parenteral nutrition are applied for the treatment. Fournier’s gangrene is rarely seen after extensive surgical operations, and if untreated it may increase the surgical mortality. Conclusion: In this article, diagnosis and the treatment of a case with a Fournier’s gangrene that developed after coronary bypass surgery and its etiological relationship with the extracorporeal circulation were discussed.

Keywords

Fournier’s gangrene, coronary artery bypass, extracorporeal circulation, therapy

References

• Eke N. Fournier’s gangrene: A review of 1726 cases. Br J Surg 2000;87(6):718-28.
• Spirnak JP, Resnick MI, Hampel N, Persky L. Fournier’s gangrene; report of 20 patients. J Urol 1984;131(2):289-91.
• Morpurgo E, Galandiuk S. Fournier’s gangrene. Surg Clin North Am 2002;82(6):1213-24.
• Smith GL, Bunker CB, Dineeen MD. Fournier’s gangrene. Br J Urol 1998;81(3):347-55.
• Thawani A, Khan A, Malik A, Cherian J, Barua J, Shergill I, et al. Fournier’s gangrene and its emergency management. Postgrad Med J 2006;82(970):516-9.
• Fournier JA. Gangrene foudroyante (overwhelming gangrene). Sem Med 1883. Dis Colon Rectum 1988;31(12):984-8.
• Clayton MD, Fowler JE Jr, Sharifi R, Pearl RK. Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet 1990; (1):49-55.
• Knudsen F, Andersen LW. Immunological aspects of cardio pulmonary bypass. Journal of Cardiothoracic Anesthesia 1990; (2):245-58.
• Norenberg RG, Sethi NK, Scott SM, Takaro T. Opportunistic endocarditis following open heart surgery. Ann Thorac Surg ;19(5):592-604. Hisatomi K, Isomura T, Kawara T. Changes in lymphocyte subsets, mitogen responsiveness and interleukin-2 production after cardiac operations. J Thorac Cardiovasc Surg ;98(4):580-91. Butler J, Chong GL, Baigrie RJ, Pillai R, Westaby S, Rocker GM. Cytokine responses to cardiopulmonary bypass with membrane and bubble oxygenation. The Annals of thoracic surgery 1992;53(5):833-8.
• Prasad K, Kalra J, Bharadwaj B, Chaudhary AK. Increased oxygen free radical activity in patients on cardiopulmonary bypass undergoing aortocoronary surgery. Am Heart J ;123(1):37-47. Jansen NJG, van Oeveren W, Gu YJ, van Vliet MH, Eijsman L, Wildevuur CR. Endotoxin release and tumor necrosis factor formation during cardiopulmonary bypass. The Annals of thoracic surgery 1992;54(4):744-8.
• Lahat N, Zlotnick AY. Serum levels of IL-1, IL-6 and TNF in patients undergoing coronary artery bypass grafts or cholesystectomy. Clinical and Experimental Immunology ;89(2):255-60. Kawamura T, Wakusawa R, Okada K, Inadat S. Elevation of cytokines during open heart surgery with cardiopulmonary bypass: participation of interleukin 8 and 6 in reperfusion injury. Canadian journal of anaesthesia 1993;40(11):1016-21.
• Kalfin RE, Engelman RM, et al. Induction of interleukin-8 expression during cardiopulmonary bypass. Circulation 1993;88 (5 pt 2):2401-6.
• Haeffner-Cavaillon N, Roussellier N, et al. Induction of interleukin-1 production in patients undergoing cardio pulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery 1989;98(6): 1100-6.
• Girardin E, Roux-Lombard P, Grau GE. Imbalance between tumour necrosis factor-alpha and soluble TNF receptor concentrations in severe meningococcaemia. The J5 Study Group. Immunology 1992;76(1):20-3.
• McBride WT, Armstrong MA, Crockard AD, McMurray TJ, Lyons SM. Selective reduction in leucocyte surface marker expression following high dose fentanyl administration at cardiac surgery. British Journal of Anesthesia 1994;73(5):717-8.
• Gillinov AM, Bator JM, Zehr KJ, Redmond JM, Burch RM, Ko C, et al. Neutrophil adhesion molecule expression during cardiopulmonary bypass with bubble and membrane oxygenators. The Annals of thoracic surgery 1993;56(4):847-53.
• McBride WT, Armstrong MA, Crockard AD, McMurray TJ, Rea JM. Cytokine balance and immunosuppressive changes at cardiac surgery: contrasting response between patients and isolated CPB circuits. British Journal of Anesthesia 1995; (6):724-33.
• Donaldson PMW, Naylor B, Lowe JW, Gouldesbrough DR. Rapidly fatal necrotizing fasciitis caused by streptecoccus pyogenes. J Clin Pathol 1993;46(7):617-9.
• Johnin K, Nakatoh M, Kadowaki T, Kushima M, Koizumi Z, Okada Y. Fournier’s gangrene caused by Candida species as the primary organism. Urology 2000;56(1):153.
• Yaghan RJ, Al-Jaberi TM, Bani-Hani I. Fournier’s gangrene: changing face of the disease. Dis Colon Rectum 2000; (9):1300-8.
• Rotstein OD, Pruett TL, Simmons RL. Mechanisms of microbial synergy in polymicrobial surgical infections. Rev Infect Dis 1985;7(2):151-70.
• Elem B, Ranjan P. Impact of immunodeficiency virus (HIV) on Fournier’s gangrene: observations in Zambia. Ann R Coll Surg Engl 1995;77(4):283-6.
• Levonsen RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics 2008;28(2):519-28.
• Czymek R, Schmidt A. Fornier’s gangrene: VAC. Am J Surg ;197(2):168-76.