Fournier’s gangrene


Necrotizing fasciitis involving male genitalia which is a life threatening infection.

A fulminant form of infective necrotizing fasciitis of the perineum and genital area.

It is a medical emergency.

Requires rapid diagnosis and surgical treatment.

Mortality rate average is 20-30%.

Usually a polymicrobial infectious disease that allows a synergistic necrotic process to invade the scrotum, peritoneum and perianal area.

Frequently associated with trauma, instrumentation and comorbid diseases such as diabetes and immunosuppression.

Can be associated with perianal infection, perirectal abscess, urethral strictures, balanitis, skin infections, indwelling catheters, hidradenitis, and penile intravenous drug abuse.

Bacteria associated are E. Coli,, Staphylococcus, Streptococcus and Proteus with an average of a minimum of three bacteria cultured from each patient.

Relatively rare but potentially fatal complication of treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitors.

Blood cultures positive in about one third of patients.

Patients present typically with itching, edema and perineal pain that is disproportional to physical examination findings.

Delayed diagnosis is due to its rarity and lack of typical signs of inflammation.

The process culminates in necrosis of the skin associated blood vessels thrombose.

Is a clinical diagnosis based on history and physical findings.

It is difficult to diagnose and missed diagnosis occurs more than 70% of the time.

Ultrasound of the scrotum may indicate the presence of subcutaneous emphysema leading to diagnosis.

Management requires rapid diagnosis, antibiotics and surgical debridement.

Treatment may require urinary and fecal diversion.

Preoperatively the anal sphincter needs to be evaluated.

Mortality ranges from 0-75% depending upon the study.

Poor outcome associated with advanced age, anemia, azotemia, hypocalcemia, hypoalbuminemia, increased alkaline phosphatase, low cholesterol level, leucocytosis, thrombocytopenia, hypokalemia and elevated LDH level.

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