Bakari Abubakar A, Ali Nuhu, Gadam Ibrahim A, Gali Bata M, Tahir Chubado, Yawe Kdt, Dahiru Adamu B, Mohammed Baba S, Wadinga Dauda
Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria ; Department of Surgery, Federal Medical Centre Yola, Yola, Adamawa State, Nigeria.
Department of Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria.
Niger J Surg. 2013 Jul;19(2):56-60. doi: 10.4103/1117-6806.119237.
Fistula-in-ano when complicated by Fournier's gangrene is an unusual finding and always carries high morbidity. This study details our experience in managing 10 cases.
Case files of all patients managed in University of Maiduguri Teaching Hospital and Federal Medical Center of Yola and Gombe from January, 2007 to December, 2011 were retrieved from Medical Record Departments and other Hospital Records. These were analyzed for demographic, clinical and pathological variables, the type of treatment and follow-up.
A total of 10 men with a mean age of 50.5 years (35-60) were managed in the period of study. Nearly, 50% of the patients were farmers, 30% businessmen and 20% were civil servant. 7 (70%) of these patients presented with Fournier's gangrene within 4 weeks of development of fistula-in-ano and the rest within 8 weeks. 4 (40%) of these patients had inadequate drainage of their perianal abscess and 2 (20%) had incision and drainage. Another 4 (40%) had spontaneously rupture of the perianal abscess. 6 (60%) of the fistula-in-ano was submuscular, 30% subcutaneous and 10% were complex or recurrent. Nearly, 20% of patients had fistulotomy and seton application for adequate drainage. Mucosal advancement flap was performed in 5 (50%) and fistulotomy in 3 (30%) patients. Another 30% had fistulotomy and continuing sitz bath.
Cryptoglandular infection is an important cause of perianal abscesses and fistula-in-ano and if poorly managed results in Fournier's gangrene. Early broad spectrum parenteral antibiotic therapy and primary surgical treatment can prevent Fournier's gangrene.
肛瘘合并福尼埃坏疽是一种罕见的情况，且总是伴随着高发病率。本研究详细介绍了我们处理10例此类病例的经验。
从迈杜古里大学教学医院以及约拉和贡贝的联邦医疗中心的病历部门和其他医院记录中检索2007年1月至2011年12月期间所有患者的病历档案。对这些档案进行人口统计学、临床和病理变量、治疗类型及随访情况的分析。
在研究期间共处理了10名男性患者，平均年龄为50.5岁（35 - 60岁）。近50%的患者为农民，30%为商人，20%为公务员。其中7例（70%）患者在肛瘘形成后4周内出现福尼埃坏疽，其余在8周内出现。这些患者中有4例（40%）肛周脓肿引流不充分，2例（20%）进行了切开引流。另外4例（40%）肛周脓肿自行破溃。6例（60%）肛瘘为肌下型，30%为皮下型，10%为复杂型或复发型。近20%的患者进行了瘘管切开术并放置挂线以充分引流。5例（50%）患者进行了黏膜推进瓣手术，3例（30%）进行了瘘管切开术。另外30%进行了瘘管切开术并持续坐浴。
腺源性感染是肛周脓肿和肛瘘的重要原因，若处理不当会导致福尼埃坏疽。早期广谱肠外抗生素治疗和一期手术治疗可预防福尼埃坏疽。
