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