Ulus Travma Acil Cerrahi Derg. 2009; 15(4): 342-346

Anorektal Bölgeyi Ýçine Alan Fournier Gangreninde Koruyucu Kolostomi Gereksinimi

Alper Akcan, Erdogan Sozuer, Hizir Akyildiz, Namik Yilmaz, Can Kucuk, Engin Ok
Erciyes Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Kayseri

AMAÇ
Bu çalýþmanýn amacý, anorektal bölgeyi içine alan Fournier gangreni olgularýnda koruyucu kolostominin gerekliliðini deðerlendirmektir.
GEREÇ VE YÖNTEM
Perianal bölgeyi içine alan 37 Fournier gangreni olgusunun týbbi kayýtlarý geriye dönük olarak deðerlendirildi. On sekiz hastaya sadece debridman uygulanýrken (Grup D), 19 hastaya debridmanýn yanýsýra Hartmann kolostomisi de uygulandý (Grup D ve HC).
BULGULAR
Gruplara arasýnda yaþ (p=0,73), cinsiyet (p=1,00), diabetes mellitus varlýðý (p=0,88), eþlik eden hastalýklar (p=0,57) ve uygulanan debridman sayýsý (p=0,75) yönünden istatistik olarak anlamlý fark saptanmadý. Medikal ve cerrahi komplikasyonlar, mortalite oranlarý, hastanede ve yoðun bakým ünitesinde kalma süreleri arasýnda anlamlý fark saptanmadý (p>0,05). Fekal diversiyon 11 hastada ilk operasyonda yapýlýrken, 6 hastada ikinci, 2 hastada ise üçüncü debridman sýrasýnda uygulandý. Bu hastalarda morbidite ayný iken, mortalite arasýnda istatistiksel olarak anlamlý fark saptandý (p=0,031).
SONUÇ
Fournier gangreni, hala zor bir klinik problemdir. Etkin multidisipliner yaklaþýmlara karþýn mortalite oraný yüksektir. Fekal diversiyon Fournier gangreni tedavisinde hala tartýþmalýdýr. Eðer gerekli ise koruyucu kolostomi ilk debridman sýrasýnda uygulanmalýdýr.

Anahtar Kelimeler: Anorektal bölge, Fournier gangreni; koruyucu kolostomi.

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Necessity Of Preventive Colostomy For Fournier’s Gangrene Of Anorectal Region

Alper Akcan, Erdogan Sozuer, Hizir Akyildiz, Namik Yilmaz, Can Kucuk, Engin Ok
Department Of General Surgery, Erciyes University, Kayseri, Turkey

BACKGROUND
The aim of this study was to evaluate the necessity of preventive colostomy for Fournier’s gangrene of the anorectal region.
METHODS
The medical records of 37 patients with perianal Fournier’s gangrene were evaluated retrospectively. Debridement(s) alone was performed in 18 patients (Group D), while debridement(s) plus Hartmann colostomy was performed in 19 patients (Group D&HC).
RESULTS
There were no statistically significant differences between the D and D&HC groups with respect to mean age (p=0.73), sex ratio (p=1.00), diabetes mellitus (p=0.88), concomitant diseases (p=0.57), and number of debridements (p=0.75). The medical and surgical complication and mortality rates and duration of hospital and intensive care unit stays were also not significantly different between the D and D&HC groups (p>0.05). Fecal diversion was done at the initial operation in 11 patients, at second operation in 6 patients, and at third operation in 2 patients. When compared, morbidity rates were similar, but mortality rates were statistically different (p=0.031).
CONCLUSION
Fournier’s gangrene remains a difficult surgical problem. Despite aggressive multidisciplinary treatment, it still has a high mortality rate. Fecal diversion in the treatment of Fournier’s gangrene is controversial. If necessary, preventive colostomy should be performed during the initial debridement.

Keywords: Anorectal region, Fournier’s gangrene; preventive colostomy.

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ATIF KOPYALA