Fournier gangrene: Difference between revisions
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==Background== | ==Background== | ||
* | *Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area. | ||
** | **Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin<ref name="Shyam">Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon. 2013 Aug;11(4):222-32. doi: 10.1016/j.surge.2013.02.001.</ref> | ||
*Risk Factors | *Risk Factors | ||
**Diabetes mellitus (most common) | **Diabetes mellitus (most common) | ||
| Line 8: | Line 8: | ||
**Advanced age | **Advanced age | ||
**Para/Quadriplegic | **Para/Quadriplegic | ||
* | *M>F (10:1)<ref name="Shyam" />, and likely under-diagnosed in women<ref name="Concepts">Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.</ref> | ||
*Mortality | *Mortality - often cited as 20-40%, but up to 80% in some studies<ref name="Concepts" /> | ||
==Clinical Features== | ==Clinical Features== | ||
*Marked pain, swelling, crepitus, ecchymosis to genital or perineal area. | *Initial event is usually local trauma or extension of a UTI or perianal infection<ref name="Shyam" /> | ||
**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, pt may present in septic shock | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*CBC | *CBC | ||
*CMP | *CMP | ||
*CRP | |||
*Lactate | *Lactate | ||
*Type and Screen | *Type and Screen | ||
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==Treatment== | ==Treatment== | ||
*Immediate surgery and urology consult for surgical debridement | *Immediate surgery and urology consult for surgical debridement (gangrene can spread at rate of 2-3 cm/hr<ref name="Shyam" />) | ||
*[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]] | *[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]] | ||
**[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr OR [[meropenem]] 500mg-1gm IV q8hr) | **[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr OR [[meropenem]] 500mg-1gm IV q8hr) | ||
*Aggressive supportive care, including fluid resuscitation (and [Vasopressors|pressors], if indicated) | |||
==Disposition== | ==Disposition== | ||
Revision as of 08:11, 2 August 2015
Background
- Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.
- Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin[1]
- Risk Factors
- Diabetes mellitus (most common)
- Hypertension
- Alcoholism
- Advanced age
- Para/Quadriplegic
- M>F (10:1)[1], and likely under-diagnosed in women[2]
- Mortality - often cited as 20-40%, but up to 80% in some studies[2]
Clinical Features
- Initial event is usually local trauma or extension of a UTI or perianal infection[1]
- 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, pt may present in septic shock
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Diagnosis
Clinical diagnosis, based on history and physical exam
Work-up
- CBC
- CMP
- CRP
- Lactate
- Type and Screen
- Wound Culture
- Blood Cultures
- CT Abdomen/pelvis (only if diagnosis unclear or if requested by surgery/urology)
Treatment
- Immediate surgery and urology consult for surgical debridement (gangrene can spread at rate of 2-3 cm/hr[1])
- Antibiotics - Must cover gram positive, gram negative, and anaerobes
- Vancomycin + (imipenem 1gm IV q24hr OR meropenem 500mg-1gm IV q8hr)
- Aggressive supportive care, including fluid resuscitation (and [Vasopressors|pressors], if indicated)
Disposition
- Admit to ICU