Fournier Gangrene is gangrene that affects the skin in the perineal, perianal, and genital areas (that comprises the scrotum, penis, and perineum).
What are the other Names for this Condition? (Also known as/Synonyms)
- Fournier Disease
- Synergic Necrotizing Fasciitis of the Perineum and Genitalia
What is Fournier Gangrene? (Definition/Background Information)
- Fournier Gangrene is gangrene that affects the skin in the perineal, perianal, and genital areas (that comprises the scrotum, penis, and perineum)
- It is a rare, serious, rapidly progressive, polymicrobial infection that results in the decay or death of tissues in the genital area, caused by both aerobic and anaerobic bacteria
- Gangrene is the decay or death of an organ or tissue in the body caused due to a lack of blood supply
- Escherichia coli is the predominant aerobe and bacteroides (Gram-negative genus bacteria) is the predominate anaerobe. It could also be the result of trauma, certain surgical procedures, or urinary tract disease, which if left unattended can be fatal
- Fournier Gangrene is characterized by pain and tenderness in the genitalia. Complications of the condition include sepsis, acute renal failure, and multi-organ failure
- A diagnosis of Fournier Gangrene requires a complete medical history, a thorough physical exam, and tests, such as pelvic scans (x-ray and CT scan) and a biopsy, to confirm the diagnosis
- The treatment of Fournier Gangrene involves surgical debridement of the tissue along with antibiotic administration to control the infection
- Fournier Gangrene is a high-mortality rate condition; an early diagnosis and prompt, aggressive treatment is essential to bring about an optimal outcome and reduce the mortality rate
Who gets Fournier Gangrene? (Age and Sex Distribution)
- Individuals (both children and adults) of any age, race, or community are susceptible to Fournier Gangrene. However, the condition commonly occurs in men, in the age group of 30-60 years
- Fournier Gangrene is less common in women because of better drainage of the perineal region through vaginal secretions
What are the Risk Factors for Fournier Gangrene? (Predisposing Factors)
The risk factors associated with Fournier Gangrene include:
- Individuals with poorly-controlled diabetes
- Individuals with suppressed immune system
- HIV infection
- Cirrhosis of liver
- Crohn’s disease: An inflammatory disease of the colon
- Extremes of age: Individuals who are very young or very old
- Systemic lupus erythematosus
- Vascular disease of the pelvis
- Men having sex with men
- Anal intercourse is an important risk factor for men
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Fournier Gangrene? (Etiology)
Gangrene is a serious medical condition when tissues die, called necrosis, due to extremely poor blood supply. Fournier’s Gangrene is a type of gangrene that affects the skin in the perineal, perianal, and genital areas.
- It is a rare condition that is caused by multiple infectious agents and pathogens
- The predominant aerobe responsible for the condition is Escherichia coli; the predominant anaerobe is bacteroides
The following are the possible causes of Fournier Gangrene in men:
- Anorectal causes: Abscesses in the perineal and anal region, anal fissures, and colonic perforations, which are caused by colorectal injury, as a result of colorectal malignancy, inflammatory bowel disease, colonic diverticulitis, or appendicitis
- Urogenital tract causes include infection in the bulbourethral glands (glands around the urethra), urethral injury, iatrogenic injury (injury from surgical procedures), epididymitis, orchitis, or lower urinary tract infections
- Dermatologic causes include hidradenitis suppurativa, ulceration, scrotal pressure and trauma, inadequate hygiene (such as with paraplegics)
- Accidental, intentional, or surgical trauma
- Presence of foreign bodies
- Genital piercings
- Penile self-injection with cocaine
- Urethral instrumentation
- Prosthetic penile implants
- Steroid enemas
The following are the possible causes of Fournier Gangrene in women:
- Septic abortions
- Vulva or bartholin gland abscesses
- Hysterectomy (surgical removal of the uterus)
The following are the possible causes of Fournier Gangrene in children:
- Strangulated inguinal hernia
- Omphalitis: Inflammation, in newborns, of the umbilical cord stump
- Insect bites
- Urethral instrumentation
- Perirectal abscesses
- Systemic infections
What are the Signs and Symptoms of Fournier Gangrene?
The common signs and symptoms associated with Fournier Gangrene include:
- Intense genital pain and tenderness
- Dusky appearance of the overlying skin
- Increased pain and tenderness in the genital area
- Discharge of pus from the wound
- Scrotal swelling
How is Fournier Gangrene Diagnosed?
The diagnosis of Fournier Gangrene may involve:
- Complete evaluation of medical history along-with thorough physical exam
- Complete blood cell count (CBC)
- Blood and urine culture; culture of any open wound or abscess
- Pelvic imaging studies: Plain radiography in the initial stages and computed tomography (CT) in the advance stages are done and may show the presence of subcutaneous air, which can help confirm the infection
- Biopsy of the affected region: It is a gold standard test to confirm the diagnosis. A small piece of tissue is taken and sent to the laboratory to be examined under the microscope by the pathologist
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Fournier Gangrene?
The possible complications of Fournier Gangrene include:
- Acute renal failure
- Diabetic ketoacidosis: A complication that occurs in diabetics. in which the body produces high levels of blood acid (called ketones)
- Multiple organ failure
Severe and untreated Fournier Gangrene can result in death.
How is Fournier Gangrene Treated?
The treatment of Fournier Gangrene depends on the severity of the condition. If the disease is confirmed, surgical excision of all necrotic tissue is required.
- Patients with systemic toxicity or organ failure require aggressive resuscitation to restore normal organ function
- Crystalloid replacement is recommended for those who are dehydrated or show signs of shock
- Tetanus prophylaxis is prescribed for patients with soft tissue injury
- Underlying comorbid conditions, such as diabetes or alcoholism, should be addressed first
Broad spectrum antibiotic therapy may be used and these include:
- Ciprofloxacin and clindamycin: Clindamycin is specifically used in the treatment of necrotizing soft tissue infections
- Ampicillin and sulbactam
- Ticarcillin and clavulanate
- Piperacillin and tazobactum combined with an aminoglycoside (metronidazole or clindamycin)
- Vancomycin is used for treatment of the bacterium Staphylococcus aureus
- Intravenous therapy along with antibody therapy and complete surgical debridement
- If the presence of fungi is traced, an antifungal agent, such as amphotericin B or Caspofungin, is used
- Hyperbaric oxygen therapy (HBO) is administered to increase tissue-oxygen tension
- Leukocyte activation, oxygen-free radical production, capillary angiogenesis, fibroblast proliferation, and vasoconstriction also helps in decreasing anaerobe multiplication
How can Fournier Gangrene be Prevented?
No specific preventive methods exist, though some precautionary measures may be adopted to reduce the risk of Fournier's Gangrene. These methods include:
- Control of diabetes: Diabetes remains the main cause that leads to Fournier Gangrene. Keeping diabetes under control can help prevent the condition
- Controlling overweight and obese body conditions can help reduce the risk of this infection
- Avoiding alcohol: Avoiding the intake of alcohol reduces or prevents the risk of Fournier's Gangrene
- Taking a healthy diet and avoiding malnutrition
What is the Prognosis of Fournier Gangrene? (Outcomes/Resolutions)
- Fournier Gangrene is a serious condition that carries a high rate of morbidity and mortality. Any delay in diagnosis and treatment of the condition can increase mortality rates
- Early diagnosis with prompt and aggressive treatment can bring about better outcomes
Additional and Relevant Useful Information for Fournier Gangrene:
The following article link will help you understand other cancers and benign tumors:
What are some Useful Resources for Additional Information?
Centers for Disease Control and Prevention (CDC)
1600 Clifton Rd. Atlanta, GA 30333, USA
Phone: (404) 639-3534
Toll-Free: 800-CDC-INFO (800-232-4636)
TTY: (888) 232-6348
References and Information Sources used for the Article:
http://www.reference.md/files/D018/mD018934.html (accessed on 5/14/2015)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2850836/ (accessed on 5/14/2015)
http://radiopaedia.org/articles/fournier-gangrene (accessed on 5/14/2015)
http://pubs.rsna.org/doi/full/10.1148/rg.282075048 (accessed on 5/14/2015)
Helpful Peer-Reviewed Medical Articles:
Katusic, J., Stimac, G., Benko, G., Grubisic, I., Soipi, S., & Dimanovski, J. (2010). Management of fournier's gangrene: case report and literature review. Acta Clin Croat, 49(4), 453-457.
Kearney, D. E., Harney, S., O'Broin, E., & McCourt, M. (2011). An unusual presentation of Fournier's gangrene. Ir J Med Sci, 180(2), 573-574. doi: 10.1007/s11845-010-0516-0
Schmale, M., Fichtner, A., Pohl, C., John, E., & Bucher, M. (2012). [Hyperbaric oxygenation for necrotizing soft tissue infections: pro]. Chirurg, 83(11), 973-979. doi: 10.1007/s00104-012-2283-0
Schnurer, S., Beier, J. P., Croner, R., Rieker, R. J., & Horch, R. E. (2012). [Pathogenesis, classification and diagnosis of necrotizing soft tissue infections]. Chirurg, 83(11), 943-952. doi: 10.1007/s00104-012-2281-2
Sroczynski, M., Sebastian, M., Rudnicki, J., Sebastian, A., & Agrawal, A. K. (2013). A complex approach to the treatment of Fournier's gangrene. Adv Clin Exp Med, 22(1), 131-135.
Eke, N. (2000). Fournier's gangrene: a review of 1726 cases. British Journal of Surgery, 87(6), 718-728.
Spirnak, J. P., Resnick, M. I., Hampel, N., & Persky, L. (1984). Fournier’s gangrene: report of 20 patients. The Journal of urology, 131(2), 289-291.
Hejase, M. J., Simonin, J. E., Bihrle, R., & Coogan, C. L. (1996). Genital Fournier's gangrene: experience with 38 patients. Urology, 47(5), 734-739.
Hollabaugh, J. R., Dmochowski, R. R., Hickerson, W. L., & Cox, C. E. (1998). Fournier's gangrene: therapeutic impact of hyperbaric oxygen. Plastic and reconstructive Surgery, 101(1), 94-100.
Laucks II, S. S. (1994). Fournier’s gangrene. Surgical Clinics of North America, 74(6), 1339-1352.