ep753 - Manometric and Sonographic Examination of Anal Sphincter Complex, and Fecal Incontinence and Quality of Life Outcomes in Fournier’s Gangrene Survivors

Purpose/Background: Fournier's gangrene (FG) is rare but life-threatening surgical emergency requiring consecutive aggressive debridement. Despite it is a necrotizing soft tissue infection, anal sphincter complex (ASC) and pelvic floor muscles may be injured during debridement. The aim of this study is to examine the impact of surgical debridement on sphincter anatomy and functions, as well as its long-term effects on patients' fecal incontinence (FI) and quality of life (QoL).Methods/Interventions: Patients who underwent debridement for FG between January 2000 and September 2021 were documented from the prospectively maintained FG database. Inclusion criteria were surgical debridement around 5cm diameter from the center of the anus, and no existing stoma. In total, 21 patients who gave informed consent were included in the study. Anorectal examination, endoanal ultrasonography (EUS), anal manometry (AM) was performed, and Cleveland Clinic Fecal Incontinence Score (CCIS) was calculated. All patients were asked to complete Short Form 36 (SF-36), and Fecal Incontinence Quality of Life (FIQL) questionnaires.Results/Outcomes: Majority of the patients were male (66.7%) with a median age of 59 (39-74). Fifteen patients had comorbidities, 10 had diabetes. Anorectal etiology was the most common presentation (61.9%), and median debridement count was 4 (1-12). Follow up time was median 83 (27-211) months. Anorectal examination showed 3 patients had anal fistula, 1 patient had anal fissure, 1 patient had external rectal prolapse, and 11 patients had low anal tonus in digital examination. EUS revealed isolated external sphincter injury in 2, and both external and internal sphincter injury in 2 patients. AM examination showed 2 patients had decreased rest pressure while 11 had decreased squeeze pressure. Questionnaires revealed that some of the patients had FI and impaired QoL (Table 1).Conclusion/

Discussion: This study showed debridement for FG may not cause anatomic impairment in ASC in the majority of patients while it may adversely affect AM pressures. Obviously, most of the patients experience FI and impaired QoL after treatment of FG. However, it is not possible to say all these findings are totally associated with FG since we do not have pre-FG data of the patients to make comparison.