Aggressiveness - the key to a successful outcome in Fournier's Gangrene.

Nine patients with Fournier's gangrene were managed during last five years in various service hospitals. Mean age was 51 years (range 21-81 years). Most of these patients were from middle and upper class. Common predisposing factors included diabetes mellitus, alcohol abuse and poor personal hygiene. Streptococcus haemolyticus, Staphylococcus aureus and E coli were the commonest organisms cultured in most of these patients. Our experience indicates that the lower gastrointestinal tract should be considered as a possible cause of infection in all patients with Fournier's gangrene as 5 patients developed this condition following anorectal abscesses. All these patients were treated with a common approach of resuscitation, broad spectrum antibiotics, immediate surgical excision of all necrotic tissue, nutritional therapy and early skin coverage without any mortality. The surgeon should be more aggressive in the initial therapy and make the first surgery more definitive. There is no place for conservative management. The patients with perianal sepsis in elderly should be referred early for surgery.