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

Abstract

Fournier's gangrene (FG) often requires repeated aggressive debridement. Its long-term effects on continence, anal sphincter integrity, and quality of life remain insufficiently defined. Among 188 patients treated for FG between 2000 and 2021 and assessed for eligibility, 21 survivors who had perianal debridement within 5 cm of the anal verge, healed without permanent stoma, and completed the study protocol were included. Participants underwent standardized physical examination, anorectal manometry, endoanal ultrasonography, and questionnaire-based assessment of fecal incontinence and quality of life. Majority of patients were male (66.7%) with a median age of 59 years (39-74). The median follow-up time was 83 months (27-211). On anorectal examination, 3 patients had anal fistula, 1 had anal fissure, 1 had external rectal prolapse, and 11 had decreased anal tone on digital examination. Endoanal ultrasonography demonstrated isolated external sphincter defects in 2 patients and combined external and internal sphincter defects in 2. Anorectal manometry showed decreased resting pressure in 2 patients and decreased squeeze pressure in 11. Questionnaire-based assessment demonstrated that fecal incontinence and reduced quality of life were common among long-term survivors. Long-term survivors of Fournier's gangrene frequently report fecal incontinence and reduced quality of life, although overt sphincter defects are uncommon.