Fournier Gangrene

Fournier Gangrene is a topic covered in the 5-Minute Emergency Consult.

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Basics

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.
  • 3 anatomic origins account for most cases:
    • Lower urinary tract (40%): Urethral strictures, indwelling catheters
    • Penile or scrotal (30%): Condom catheters, hydradenitis, 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

  • Infection by polymicrobial flora (mixed aerobic and anaerobic organisms)
  • 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.
  • Risk factors:
    • Trauma
    • Diabetes
    • Alcoholism
    • Other immunocompromised states
    • Morbid obesity
    • Abdominal surgery

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