Retrospective Study
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World J Gastroenterol. Jun 28, 2014; 20(24): 7950-7954
Published online Jun 28, 2014. doi: 10.3748/wjg.v20.i24.7950
Enterostomy can decrease the mortality of patients with Fournier gangrene
Yan-Dong Li, Wei-Fang Zhu, Jian-Jun Qiao, Jian-Jiang Lin
Yan-Dong Li, Jian-Jiang Lin, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Wei-Fang Zhu, Jian-Jun Qiao, Department of Dermatology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Li YD and Zhu WF determined the research theme; Li YD, Zhu WF, Qiao JJ and Lin JJ designed the methods and prepared the manuscript; Li YD, Qiao JJ and Zhu WF analyzed and interpreted the data; all authors have read and approved the final version of the manuscript to be published.
Correspondence to: Dr. Wei-Fang Zhu, Department of Dermatology, First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Hangzhou 310003, Zhejiang Province, China. wfzhu@163.com
Telephone: +86-571-87236559 Fax: +86-571-87236559
Received: February 18, 2014
Revised: April 8, 2014
Accepted: April 28, 2014
Published online: June 28, 2014
Processing time: 128 Days and 12.1 Hours
Abstract

AIM: To determine the significance of enterostomy in the emergency management of Fournier gangrene.

METHODS: The clinical data of 51 patients (49 men and 2 women) with Fournier gangrene who were treated at our hospital over the past 12 years were retrospectively analyzed. The patients were divided into two groups according the surgical technique performed: enterostomy combined with debridement (the enterostomy group, n = 28) or debridement alone (the control group, n = 23). Patients in the enterostomy group received thorough debridement during surgery and adequate local drainage after surgery, as well as administration of broad-spectrum antibiotics. The clinical data and outcomes in both groups were analyzed.

RESULTS: The surgical procedures were successful in both patient groups. In the enterostomy group, 10 (35.8%) patients required skin grafting with a total of six debridement procedures. While in the control group, six (26.1%) patients required four debridement procedures. However, this difference was not statistically significant. Following surgery, the time to normal body temperature (6 d vs 8 d, P < 0.05) and average length of hospital stay (14.3 ± 7.8 d vs 20.1 ± 8.9 d, P < 0.05) were shorter in the enterostomy group. The case fatality rate was lower in the enterostomy group than that in the control group (3.6% vs 21.7%, P < 0.05).

CONCLUSION: Enterostomy can decrease the case fatality rate of patients with Fournier gangrene.

Keywords: Fournier gangrene; Necrotizing fasciitis; Enterostomy; Surgery; Infection

Core tip: Fournier gangrene presents as a severe disease with a high mortality. In this study, 51 patients with Fournier gangrene who received enterostomy (enterostomy group) or not (control group) over the past 12 years were included. Their postoperative recovery and outcomes were compared. Ten patients in the enterostomy group and six patients in the control group required skin grafting. Compared with the control group, the time to normal body temperature and average length of hospital stay were significantly shorter, and the case fatality rate was lower, in the enterostomy group. Enterostomy can decrease the fatality rate of Fournier gangrene.