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A Journal on Surgery

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Chirurgia 2004 April;17(2):75-6

language: English

Fournier's gangrene. Treatment in the frail elderly

Carnazzo S. A., Laurentini G. M., Samperisi L.


Fournier's gangrene is a rare necrotising perineal infection caused by anaerobic bacteria requiring intensive medical treatment and surgery, usually with colostomy. Delayed colostomy is considered to be a negative prognostic factor. A number of authors have recently questioned the need for wide excision and colostomy. The authors of this paper used the new and less invasive technical indications put forward for the treatment of pelvirectal gangrene. The case of an 85-year-old female affected by a generalised septic state due to necrosis of the perineum with genital involvement maintained by Escherichia Coli and Bacteroides fragilis is reported. The patient underwent surgery for the excision of the necrotic areas and abscess draining and debriding. The subject did not undergo colostomy. Septic state and necrotising infection were seen to improve rapidly following surgery with the lesions healing in the space of 45 days. The lack of colostomy did not influence the speed of recovery and affected only the number of dressings and the care with which these were applied. Colostomy in the treatment of Fournier's gangrene may be avoided in elderly subjects with serious pathologies provided that the necrotic-purulent areas are carefully drained and the lesions are carefully and frequently disinfected.

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