Fournier gangrene: Difference between revisions
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**Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin | **Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin | ||
*Risk Factors | *Risk Factors | ||
**Diabetes mellitus | **Diabetes mellitus (most common) | ||
**Hypertension | **Hypertension | ||
**Alcoholism | **Alcoholism | ||
**Advanced age | **Advanced age | ||
**Para/Quadriplegic | **Para/Quadriplegic | ||
*Under diagnosed in women<ref>Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.</ref> | *Under diagnosed in women<ref name="Concepts">Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.</ref> | ||
*Mortality | *Mortality | ||
**Most often 20-40%, but | **Most often cited as 20-40%, but up to 80% in some studies<ref name="Concepts" /> | ||
==Clinical Features== | ==Clinical Features== | ||
*Marked pain, swelling, crepitus, ecchymosis to genital or perineal area. | |||
*Marked pain, swelling, crepitus, ecchymosis | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 20: | Line 19: | ||
==Diagnosis== | ==Diagnosis== | ||
'''Clinical diagnosis, based on history and physical exam''' | |||
===Work-up=== | |||
*CBC | *CBC | ||
* | *CMP | ||
* | *Lactate | ||
*Type and Screen | |||
*Wound Culture | |||
*Blood Cultures | *Blood Cultures | ||
*CT Abdomen/pelvis (only if diagnosis unclear or if requested by surgery/urology) | |||
*CT | |||
==Treatment== | ==Treatment== | ||
*[[Antibiotics]] | *Immediate surgery and urology consult for surgical debridement | ||
*[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]] | |||
**[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr OR [[meropenem]] 500mg-1gm IV q8hr) | |||
==Disposition== | ==Disposition== | ||
* | *Admit to ICU | ||
==See Also== | ==See Also== | ||
Revision as of 07:40, 2 August 2015
Background
- Polymicrobial necrotizing fasciitis of perineal, genital, or perianal anatomy
- Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin
- Risk Factors
- Diabetes mellitus (most common)
- Hypertension
- Alcoholism
- Advanced age
- Para/Quadriplegic
- Under diagnosed in women[1]
- Mortality
- Most often cited as 20-40%, but up to 80% in some studies[1]
Clinical Features
- Marked pain, swelling, crepitus, ecchymosis to genital or perineal area.
Differential Diagnosis
Testicular Diagnoses
- Scrotal cellulitis
- Epididymitis
- Fournier gangrene
- Hematocele
- Hydrocele
- Indirect inguinal hernia
- Inguinal lymph node (Lymphadenitis)
- Orchitis
- Scrotal abscess
- Spermatocele
- Tinea cruris
- Testicular rupture
- Testicular torsion
- Testicular trauma
- Testicular tumor
- Torsion of testicular appendage
- Varicocele
- Pyocele
- Testicular malignancy
- Scrotal wall hematoma
Diagnosis
Clinical diagnosis, based on history and physical exam
Work-up
- CBC
- CMP
- Lactate
- Type and Screen
- Wound Culture
- Blood Cultures
- CT Abdomen/pelvis (only if diagnosis unclear or if requested by surgery/urology)
Treatment
- Immediate surgery and urology consult for surgical debridement
- Antibiotics - Must cover gram positive, gram negative, and anaerobes
- Vancomycin + (imipenem 1gm IV q24hr OR meropenem 500mg-1gm IV q8hr)
Disposition
- Admit to ICU