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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

Barkin, Adam Z., 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: Barkin AZ, Barkin RM, Hayden SR, 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 February 18, 2019.

Fournier Gangrene. (2016). In Barkin, A. Z., Barkin, R. M., Hayden, S. R., Rosen, P., Schaider, J. J., Shayne, P., & Wolfe, R. E. (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: Barkin AZ, Barkin RM, Hayden SR, Rosen P, Schaider JJ, Shayne P, Wolfe RE, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 February 18]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307215/all/Fournier_Gangrene

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case

TY - ELEC T1 - Fournier Gangrene ID - 307215 ED - Barkin,Adam Z, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Shayne,Philip, ED - Wolfe,Richard E, 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 -