Fourniere’s gangrene after anorectal surgery: our experience

Background Fourniere’s gangrene is a disease characterized by necroziting fasciitis of the perineal and genital region. Systemic diseases are generally associated. We present our experience of Fournier’s gangrene occurring as a complication after anorectal surgery. Methods Four cases of Fourniere’s gangrene were observed. A 49-year-old man, affected by diabetes mellitus and renal failure, underwent an internal lateral sphincterotomy. Six days later, he presented to our office with perianal pain and fever (40C with WBC = 28.000). In a second male patient affected by diabetes mellitus and hypertension, an anal abscess was treated with a surgical incision and with an antibiotic therapy. Two days later, he presented with high fever (39.7C), leucocytosis (39.000), and pain. A 24-year-old women affected by a NH Lymphoma presented with a recto-vaginal fistula. She underwent surgery but 20 days after, Fourniere’s gangrene developed. A 54-yearold man with bone marrow aplasya following chemotherapy for a lymphoma presented with Fourniere’s gangrene after hemorrhoidal thrombosis. CT scan and MRI were used to confirm diagnosis. Results The patients were treated with fluid resuscitation followed by initial debridment. A broad spectrum antibiotic therapy was started. Daily surgical debridement of necrotic areas and irrigation with hydrogen peroxide were performed in all patients. Hyperbaric oxygen therapy was performed in the first two patients. The first two patients healed. The other two patients died for the progression of neoplastic disease. Conclusions Fourniere’s gangrene is a potentially lethal infection of the anogenital area. An aggressive multidisciplinary therapy is necessary to achieve complete resolution.