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Fourniers Gangrene

B86401099

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What is a Gangrene?

Death of tissue, usually in considerable mass

and generally associated with loss of vascularsupply and followed by bacterial invasion and

putrefaction.

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Definition

Fournier(1832-1914):

Fulminant gangrene of the penis and scrotum

Sudden onset in an hitherto healthy young man

Rapid progression to gangrene

Absence of a definite cause

Dorlands Illustrated Medical Dictionary 29th edition:

An acute gangrenous type of necrotizing fasciitis of the

scrotum, penis, or perineum involving Gram-Positive

organisms, enteric bacilli, or anaerobes.

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Anatomy

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Risk factors

Male : Female = 10 : 1

Immunocompromised

Hygiene problems

Post-surgical

Alcoholism

Diabetes mellitus

Cancer, HIV

Low social economic statusIndwelling catheters

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Etiology

Dermatological

Anorectal

Urological

Intra-abdominal

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Pathophysiology

Synergistic necrotizing fasciitis

InfectionThrombosis of

small subcutaneous

vessels

Development of

gangrene

Common pathogens:

Streptococci, Staphylococci, Enterococci,

Corynebacteria

E.coli, Klebsiella, Proteus

Bacterioides, Clostridia

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Clinical Presentation

Toxic in appearance, Lethargy

Nausea and Vomiting

Fever with Chills

Pain is out of portion in examination

Insensate finally

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Bronze or Violaceous

discoloration of the

skin

Thin brown watery

discharge

Ulceration,

Bullous vesicles,

Subcutaneous gas

Clinical Presentation

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Treatment

ABCs

Central venous access

Fluid resuscitation

Empirical broad spectrum antibiotics

Early emergent surgical debridementHyperbaric Oxygen therapy

Electrolyte and Metabolic control

Blood product if indicated

Penicillins with -lactamase inhibitor,Carbapenems

Penicillins + 3rdcephalosporins + aminoglycosides+ clindamycin or metronidazole

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Morbidity and Complacations

Morbidity:

Duration of hospital stay: 2-278 days

Complications:

Great tissue loss lead to sacrifice the testes.

Penile gangrene may result in total loss of penis.DKA may appear in the course.

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Mortality and Prognosis

Factor associated with mortality:

Age > 60 y/o

Unstable hemodynamic status

Anorectal sourceRenal or Hepatic dysfunction

Delay treatment

Patients with more than 5% BSA involvement

Mortality rate: 16% (3-45)

Cause of Death:

Severe sepsis, Coagulopathy, ARF, DKA, MOF

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Summary

Fourniers Gangrene is a clinical diagnosis.

Pathophysiology: Gangrenous type of synergistic

necrotizing fasciitis of scrotum, penis, or perineum.

Etiology: Dermatological, Anorectal, Urological.

Treatment: Initial stabilization, Surgical debridement,Empirical broad spectrum antibiotics coverage.

Mortality: around 16% (3-45%)

Risk factors: Immunocompromised, Poor hygiene.

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Reference

Fourniers gangrene: a review of 1726 cases. Eke N.

Br J Surg. 2000 Jun;87(6):718-28.

Fournier's gangrene.Morpugo E, Galandiuk S.

Surg Clin North Am. 2002 Dec;82(6):1213-24.The 5 Minute Emergency Medicine Consult. 2002

Aug; LWW

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Thanx for your attention!

Night of Kodaiji Kyoto. Aug 2002