Fournier Gangrene
Basics
Description
Description
- Inadequate hygiene leads to scrotal skin maceration and excoriation:
- Portal of entry for bacteria in tissue
- Once skin barrier is broken, polymicrobial flora spread along fascial planes of perineum
- Colles fascia fuses with urogenital diaphragm, slowing propagation posteriorly and laterally
- Anteriorly, Buck and Scarpa fascia are continuous, allowing rapid extension to anterior abdominal wall and laterally along fascia lata
- Testes and urethra are usually spared
- Three anatomic origins account for most cases:
- Lower urinary tract (40%): Urethral strictures, indwelling catheters
- Penile or scrotal (30%): Condom catheters, hidradenitis, balanitis
- Anorectal (30%): Fistulas, perirectal infections, hemorrhoids
- Rarely, intra-abdominal sources such as perforating appendicitis, diverticulitis, or pancreatitis have produced Fournier gangrene by dependent contiguous spread
Etiology
Etiology
- Infection by polymicrobial flora (mixed aerobic and anaerobic organisms; often of skin or bowel origin)
- Mixed bacteria exert synergistic tissue-destructive effect
- End-arterial thrombosis in subcutaneous tissues produces anaerobic environment
- Bacterial toxins and tissue necrosis factors may contribute to clinical presentation
- Rare cases have shown candidal infections causing Fournier gangrene
- Risk factors:
- Trauma
- Diabetes
- Alcoholism
- Other immunocompromised states
- Morbid obesity
- Abdominal surgery
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Citation
Schaider, Jeffrey J., et al., editors. "Fournier Gangrene." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene.
Fournier Gangrene. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene. Accessed December 11, 2024.
Fournier Gangrene. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene
Fournier Gangrene [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 11]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene.
* Article titles in AMA citation format should be in sentence-case
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BT - 5-Minute Emergency Consult
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