Fournier gangrene

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Background

  • Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.
    • Mostly bacteria lower GI system - B. fragilis and E. coli
    • Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin[1]
  • Mortality - often cited as 20-40%, but up to 80% in some studies[2]

Risk Factors

Clinical Features

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Fournier's Gangrene
  • Initial event is usually local trauma or extension of a UTI or perianal infection[1]
    • Gangrene develops over 2-7 days
  • Marked pain, localized swelling, crepitus, ecchymosis to genital or perineal area.
  • Fever
  • Malodorous purulent drainage
  • In late or severe cases, patient may present in septic shock

Differential Diagnosis

Testicular Diagnoses

Evaluation

Work-up

  • CBC - very elevated leukocytosis
  • CMP - hyponatremia
  • ESR
  • CRP
  • Lactate
  • Type and Screen
  • Wound Culture
  • Blood Cultures
  • CT Abdomen/pelvis (only if diagnosis unclear or if requested by surgery/urology)

Evaluation

Management

Disposition

  • Admit to ICU

See Also

References

  1. 1.0 1.1 1.2 1.3 Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon. 2013 Aug;11(4):222-32. doi: 10.1016/j.surge.2013.02.001.
  2. 2.0 2.1 Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.