Saving Gonads in Acute Life-Threatening Fournier's Gangrene-A Challenge: A Tertiary Care Centre Study!

Background Necrotising fasciitis of scrotum, also known as Fourniers Gangrene, is a rare gangrenous infection of urogenital and anorectal areas which progresses rapidly at an alarming rate. Aggressive, effective and early treatment of this condition is imperative to prevent a fatal outcome. In this study we aimed to analyse the clinical presentation of the patients presenting with Fourniers Gangrene and modalities adopted to preserve the gonads. Methods Prospective observational study of 05 patients of Fourniers Gangrene admitted to General Surgery ward of a tertiary care hospital during the 18 months period between January 2016 and June 2017 was done to analyse the clinical parameters and surgical modalities with emphasis on testis preserving techniques. Results 05 male patients were enrolled in the study. The mean age of the patient was 53 years. The common presenting symptoms in these patients were local pain, fever, scrotal swelling and oedema. Chronic Kidney Disease, Diabetes Mellitus and Hypertension were the predominant comorbidities in this series. The length of hospital-stay varied from 20 to 45 days (mean 29.2). The surgical modalities included serial debridement, saline and povidone iodine dressings and NPWT application followed by secondary closure. The various techniques advocated for testis preservation included creation of sub-inguinal pouch and placement of testis in the opposite hemi-scrotum. Mortality was nil. Follow-up of cases at 3 months and 06 months had a satisfactory outcome. Conclusion Fourniers Gangrene is an increasingly common problem, characterized by progressive and potentially fatal infection of scrotal and perineal regions. Any delay in diagnosis is potentially catastrophic, as the concomitant delay in surgical therapy is a direct predictor of mortality.