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Publications

Journal Article Review Ahead of print

PubMed: 42062112 DOI: 10.1016/j.jviscsurg.2026.03.006

How to manage pelvic-perineal necrotic bacterial dermohypodermitis.

J Visc Surg

Authors: Alexandra Pellegrin, Charles Sabbagh, Jean-Marc Regimbeau, Octave Charvillat, Rodolphe Chartier, Arnaud Alves

Affiliations

  • Service de chirurgie digestive et viscérale, CHU d'Amiens Picardie, 80000 Amiens, France; UR UPJV 7518, SSPC, université de Picardie Jules-Verne, 80000 Amiens, France.
  • Service de chirurgie digestive et viscérale, CHU d'Amiens Picardie, 80000 Amiens, France; UR UPJV 7518, SSPC, université de Picardie Jules-Verne, 80000 Amiens, France.
  • Service de chirurgie plastique, reconstructrice et esthétique, CHU d'Amiens Picardie, 80000 Amiens, France.
  • Registre des tumeurs digestives du Calvados, unité Inserm UMR 1086 ANTICIPE, service de chirurgie digestive et viscérale, CHU de Caen, université de Caen Normandie, 14000 Caen, France.

Abstract

Pelvic-perineal necrotic bacterial dermohypodermitis, also known as Fournier's gangrene, is a rare infection, at 1.6/100,000, affecting males in more than 95% of cases, frequently overwhelming and with very poor prognosis. It is polymicrobial in more than 80% of cases, spreading rapidly in the subcutaneous perineal tissue due to bacterial enzymes. Recent mortality estimates were between 7.5 and 20%. The main risk factors, related to impairment of immunity and microcirculation, include diabetes, smoking and alcohol abuse, obesity, HIV infection, cardiac, renal and/or hepatic comorbidity, and cancer. Diagnosis is primarily clinical. Presentation typically associates fever, intense pain, scrotal edema, cutaneous erythema and subcutaneous crepitation, with possible rapid progression to septic shock. Prognostic scores have been developed, but their use should never delay implementation of abdominal-pelvic CT and surgery. Debridement needs to be carried out early, within 12hours of symptom onset; mortality is increased 3-fold if the delay exceeds 14hours: 24 versus 69%. Management is sequential and multidisciplinary, associating hemodynamic stabilization, broad-spectrum probabilistic antibiotic therapy, and iterative "skin-sparing" debridement, which improves the rate of delayed primary closure (7 vs. 38%; P=0.002) and hospital stay (26 vs. 46 days; P=0.02), and facilitates secondary reconstruction.

MeSH

Mortality, General Surgery, Infections