Fournier Gangrene

An infection of the genitalia, Fournier's gangrene affects the male perineum and scrotum, causing severe pain in the genital area. The infection quickly progresses from redness to tissue death. The tissue damage may be too severe for the patient to recover, as gangrene can occur within hours.The bacterial infection spreads speedily from the urinary tract. Some of the bacteria work more aggressively to cause a more invasive infection.

Signs & Symptoms

From the outset, the patient experiences pain, redness of the skin, edema, dark discoloration of the skin, tenderness, blistering, swelling, and ulceration. In cases of severe infection, subcutaneous necrosis occurs simultaneously beneath the surface tissues, causing severe toxaemia. In such cases, the death of tissue can extend to the thighs and chest wall through the abdominal wall.Fournier gangrene is characterized by redness and pain in the scrotum, which rapidly progresses to discoloration of the skin and sloughing of tissue.Other symptoms may include general discomfort, fever, and inflammation in the genital and anal areas. The condition is often associated with smell of the affected tissues, which leads to full blown gangrene.

Risk Factors

Males are more prone to this infection compared to females and children. However, the disorder can occur in infants and adolescents following trauma, insect bites, infections, burns, and perirectal diseases.Other risk factors include impaired immune function, surgery, trauma, or urinary catheterization. Fournier gangrene may occur along with other disorders that weaken the immune system. Other conditions that increase your risk of the disease include obesity, diabetes mellitus, cirrhosis, malignancies, and inadequate blood supply to the pelvis.

Causes

Fungi, bacteria, and/or viruses may be responsible for Fournier gangrene. When the compromised immune system is not able to prevent spread of infection, the virulent microorganism can easily gain access to the host.Group A streptococci bacterial may be responsible for causing the infection. Or it could be caused as a result of polymicrobial infection, with different organisms, including Staphylococcus aureus, fusobacterium, or bacteroides.When these bacteria work in synergy, it could result in a more invasive disease.Early diagnosis can help save the life of the patient. Tissue from debridement is tested in a laboratory for diagnosis. Ultrasound evaluation may help differentiate between other acute inflammatory conditions and Fournier gangrene.While ultrasonography may be done to detect gases, an X-ray may be conducted to confirm the extent of gas in the wounds.

Treatment

Since the mortality rate is more than 50% in the case of Fournier’s Gangrene, treatment is urgent and involves excision of the affected and necrotic fascia. This may be followed up with broad-spectrum intravenous antibiotic therapy.Patients with severe blood infection face a severe risk of thrombembolic phenomena, which is the formation of blood clots. Additional medication may be required to lower the risk of thrombosis. When infection is controlled, reconstructive surgery is performed.