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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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Citation

Rosen, Peter, et al., editors. "Fournier Gangrene." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene.
Fournier Gangrene. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene. Accessed April 24, 2019.
Fournier Gangrene. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene
Fournier Gangrene [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 24]. 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
TY - ELEC T1 - Fournier Gangrene ID - 307215 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -