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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