Gangrenous cholecystitis is a kind of acute cholecystitis, whose course of disease progresses rapidly, early diagnosis is difficult and mortality is high, and clinicians are prone to misdiagnosis and missed diagnosis in clinical work.However, gangrenous cholecystitis has been ignored in various guidelines.This paper systematically summarized the pathogenesis, pathological manifestations, epidemiology, clinical diagnosis and treatment of gangrenous cholecystitis, hoping to provide a complete and clear diagnosis and treatment process for clinicians.
Cholecystectomy ; Cholecystitis/surgery* ; Cholecystitis, Acute/surgery* ; Gangrene/surgery* ; Humans

OBJECTIVETo sum up the experience in diagnosis and treatment of Fournier's gangrene and find an optimal evaluation tool for its prognosis by comparing currently used prognostic scoring systems.

METHODSWe retrospectively analyzed 16 cases of Fournier's gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), Age-Adjusted Charlson Comorbidity Index (ACCI), and Surgical Apgar Score (sAPGAR) , we obtained the prognostic scores of the patients and made comparisons among different scoring systems.

RESULTSFGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score.

CONCLUSIONBoth ACCI and UFGSI are useful for evaluating the prognosis of Fournier's gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.

Age Factors ; Aged ; Fournier Gangrene ; diagnosis ; mortality ; surgery ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index

OBJECTIVE: The study aimed to describe the pen-operative complications of Fournier's gangrene in series of patients.

METHODOLOGY: A descriptive study was done using cross-sectional study design among patients diagnosed with Fournier's gangrene from January 1, 2010 to December 31, 2013. All patients regardless of age with extensive infection of the scrotum, genitalia, or perineum who underwent debridement and wide surgical excision of scrotal and/or perineal necrosis along with other involved areas and diagnosed with Fournier's gangrene postoperatively within the study period at JRRMMC was included in the study.

RESULTS: The study included 25 patients. Of these, 48% (12/25) of subjects with Fournier's gangrene had perioperative complication. Results also showed that number of hospital stay ranged from less than 24 hours to 42 days (mean of 10.5 days). Distribution of subjects by etiologic cause of Fournier's gangrene showed that majority of the etiologic cause of Fournier's gangrene were colorectal with 68% (17/25). Genital cause only comprised 32% (8/25) of the etiologic cause of Fournier's gangrene. The most frequent predisposing factor identified was diabetes mellitus.

CONCLUSION: Fournier's gangrene remains a surgical and urological emergency. Many patients may present with only minor skin lesions in the early stages of the disease. Rapid and accurate diagnosis remains a key component in achieving a successful outcome.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Young Adult ; Fournier Gangrene-surgery, complications

INTRODUCTIONSevere perianal sepsis is often difficult to manage after surgical debridement due to faecal contamination. Diversion of the faecal stream has been attempted with faecal pouches and rectal tubes, and in some cases, a diverting stoma is created. However, reversal of the stoma may be delayed due to prolonged sepsis and this is not without risks. Herein, we review the use of a flexible faecal management system in patients with severe perianal sepsis.

METHODSWe retrospectively evaluated 15 patients who made use of the ConvaTec Flexi-Seal® Fecal Management System (FMS) between 1 January 2007 and 31 December 2010. The demographics and comorbidities of the patients, as well as the treatment received, were recorded and reviewed.

RESULTSNone of the patients required the creation of a stoma to divert the faecal stream. Nursing requirements and wound care were found to be improved with the use of the Flexi-Seal® FMS (fewer changes were needed). No severe complications were observed in our series. Two deaths were encountered, but the cause of death was not directly due to the initial perianal sepsis. Overall, the wound healing rate was 80.0%, with one graft failure (11.1%).

CONCLUSIONThe use of the Flexi-Seal® FMS in patients with perianal sepsis following extensive debridement is feasible and can be considered before stoma creation.

Adult ; Aged ; Anti-Bacterial Agents ; Bacterial Proteins ; isolation & purification ; Catheters, Indwelling ; Debridement ; Enterococcus ; isolation & purification ; Fasciitis, Necrotizing ; microbiology ; surgery ; Feces ; Female ; Fournier Gangrene ; microbiology ; Hemolysin Proteins ; isolation & purification ; Humans ; Klebsiella ; isolation & purification ; Male ; Middle Aged ; Perineum ; microbiology ; Rectum ; microbiology ; Retrospective Studies ; Sepsis ; diagnosis ; drug therapy ; microbiology ; therapy ; Singapore ; Surgical Stomas ; Treatment Outcome ; Wound Healing

OBJECTIVETo review the clinical characteristics and treatment strategies of Fournier's gangrene in HIV-positive patients.

METHODSWe retrospectively analyzed the clinical characteristics and therapeutic methods of 29 HIV-positive cases of Fournier's gangrene.

RESULTSThe patients were aged 21-81 (mean 34.2) years, 27 < or = 47 years and the other two 79 and 81 years old, respectively. All the patients were HIV positive and diagnosed as having Fournier's gangrene, with CD4+ T lymphocyte count < 320/mm3, and none had received any antiretroviral therapy. The two aged patients were complicated by diabetes mellitus. All the cases originated in scrotal or penile infection, with later involvement of the surrounding skin soft tissues. Aggressive surgical debridement, incision-drainage and broad-spectrum antibiotic medication were initiated right after admission, and scrotoplasty was performed for 4 cases. Twenty-six of the patients were recovered and the other 3 (10.3%) died after surgery, 1 from infectious shock and 2 from diabetes mellitus complicated by pulmonary infection and renal failure.

CONCLUSIONTimely aggressive surgical debridement, incision-drainage and broad-spectrum antibiotic medication are essential for the treatment of Fournier's gangrene in HIV-positive patients. We did not find any direct adverse impact of HIV infection on the prognosis of Fournier's gangrene.

Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; therapeutic use ; Debridement ; Fournier Gangrene ; complications ; surgery ; HIV Infections ; complications ; Humans ; Male ; Prognosis ; Retrospective Studies ; Scrotum ; surgery ; Young Adult

BACKGROUNDMortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients.

METHODSWe retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China's Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene.

RESULTSOf 226 patients with limbs open injuries sustained during the earthquake, 53 patients underwent smear analysis of wound exudates and gas gangrene was diagnosed in 19 patients. The average elapsed time from injury to arrival at the hospital was 72 hours, from injury to definitive diagnosis was 4.3 days, and from diagnosis to conversion of negative findings on wound smear analysis to positive findings was 12.7 days. Anaerobic cultures were also obtained before wound closure. The average elapsed time from completion of surgery to recovery of normal vital signs was 6.3 days. Of the 19 patients, 16 were treated with open amputation, two with closed amputation, and 1 with successful limb salvage; 18 patients were successfully treated and one died.

CONCLUSIONSIn earthquakes, rapid, accurate screening and isolation are essential to successful treatment of gas gangrene and helpful in preventing nosocomial diffusion. Early and thorough debridement, open amputation, and active supportive treatment can produce satisfactory therapeutic results.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Earthquakes ; Extremities ; pathology ; surgery ; Female ; Gas Gangrene ; diagnosis ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

This report highlights the rare occurrence of a huge gangrenous Meckel's diverticulum in an adult, which was managed successfully with laparoscopic resection. A 45-year-old woman presented with a one-day history of right iliac fossa pain with fever and vomiting. Computed tomography showed a huge gangrenous Meckel's diverticulum. The patient underwent laparoscopic exploration and extracorporeal stapled resection of the Meckel's diverticulum. This case serves to highlight the safety and feasibility of performing a laparoscopic resection of a huge gangrenous Meckel's diverticulum in an adult.
Female ; Gangrene ; diagnostic imaging ; surgery ; Humans ; Laparoscopy ; Meckel Diverticulum ; diagnostic imaging ; surgery ; Middle Aged ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo study the clinical characteristics and treatment of Fournier's gangrene.

METHODSWe retrospectively analyzed the clinical data of 23 cases of Fournier's gangrene, all with flare and pains in the scrotum and penis and different degrees of involvement of the scrotum, penis, perianal area, perineum, inguinal and lower extremities. The patients were treated by early debridement, incision-drainage, anti-infection and hyperbaric oxygen therapy, respectively. Scrotoplasty was performed for 11 of the cases, penile and scrotal dermatoplasty for 7, and penile amputation and urethral fistulation for 2 with penile necrosis. One of the cases underwent suprapubic cystostomy, and another 1 received colostomy.

RESULTSTwenty of the patients were recovered and 3 (1 with diabetes and 1 with AIDS) died after surgery.

CONCLUSIONFournier's gangrene is a fatal disease. Early diagnosis and timely surgical intervention are essential for the management of the disease.

Adult ; Aged ; Fournier Gangrene ; diagnosis ; surgery ; therapy ; Humans ; Male ; Middle Aged ; Penis ; pathology ; surgery ; Retrospective Studies ; Scrotum ; pathology ; surgery

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.
Child ; Diagnosis, Differential ; Female ; Gangrene ; Hernia/complications/*diagnosis/radiography ; Humans ; Ileal Diseases/*diagnosis/radiography/surgery ; Intestinal Obstruction/etiology/radiography ; Intestine, Small/*pathology/surgery ; Mesentery ; Tomography, X-Ray Computed

During recent years, cases of toxic shock syndrome have been reported with increasing frequency in plastic surgery patients. The majority of reports relate to aesthetic plastic surgical procedures such as rhinoplasty, augmentation mammoplasty, liposuction, and chemical peeling. We report a case of toxic shock syndrome with necrotizing fascitis after liposuction in a 23-year-old woman who had erythema and edema, blister formation and gangrene in the skin. The patient was admitted to the intensive care unit, and treatment was initiated with vigorous fluid resuscitation and intravenous antibiotic therapy. During the next days, the condition of the patient worsened, and pulmonary insufficiency required intubation and mechanical ventilation. Surgical treatment with multiple incision and irrigation was performed on the first, third and eighteenth day. The patient was discharged in good health on the 30th day after admission. Toxic shock syndrome with necrotizing fascitis is a rare disease; therefore, it is important to review its diagnostic and clinical features as only early diagnosis and prompt, radical surgery improves the survival rate.
Blister ; Early Diagnosis ; Edema ; Erythema ; Fasciitis, Necrotizing ; Female ; Gangrene ; Humans ; Intensive Care Units ; Intubation ; Lipectomy ; Mammaplasty ; Polymethacrylic Acids ; Respiration, Artificial ; Resuscitation ; Rhinoplasty ; Shock, Septic ; Skin ; Surgery, Plastic ; Young Adult