Fournier gangrene: Difference between revisions
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*Polymicrobial necrotizing fasciitis of perineal, genital, or perianal anatomy | *Polymicrobial necrotizing fasciitis of perineal, genital, or perianal anatomy | ||
**Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin | **Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin | ||
*Risk | *Risk Factors | ||
**Diabetes mellitus | |||
**Hypertension | |||
**Alcoholism | |||
**Advanced age | |||
**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> | |||
*Mortality | |||
**Most often 20-40%, but ranges from 4% to 80%<ref><ref>Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.</ref></ref> | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Template:Testicular DDX}} | {{Template:Testicular DDX}} | ||
==Labs== | |||
*CBC | |||
*Electrolytes | |||
*CRP | |||
*Blood Cultures | |||
*Type and Screen | |||
*Culture from wound/pus | |||
*CT Abd/pel: typically to assess extent of disease process | |||
*EKG (pre-op) | |||
*Foley (pre-op) | |||
==Treatment== | ==Treatment== | ||
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*[[EBQ:LRINEC Score]] | *[[EBQ:LRINEC Score]] | ||
== | ==References== | ||
<references/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category:GU]] | [[Category:GU]] | ||
Revision as of 01:24, 11 April 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
- Hypertension
- Alcoholism
- Advanced age
- Para/Quadriplegic
- Under diagnosed in women[1]
- Mortality
- Most often 20-40%, but ranges from 4% to 80%Cite error: Closing
</ref>missing for<ref>tag</ref>
- Most often 20-40%, but ranges from 4% to 80%Cite error: Closing
Clinical Features
- Benign infection or simple abscess that rapidly becomes virulent
- Marked pain, swelling, crepitus, ecchymosis
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
Labs
- CBC
- Electrolytes
- CRP
- Blood Cultures
- Type and Screen
- Culture from wound/pus
- CT Abd/pel: typically to assess extent of disease process
- EKG (pre-op)
- Foley (pre-op)
Treatment
- Antibiotics
- Must cover gram positive, gram negative, and anaerobes
- Vancomycin + (imipenem 1gm IV q24hr OR meropenem 500mg-1gm IV q8hr)
- Must cover gram positive, gram negative, and anaerobes
- Surgical debridement
Disposition
- Urologic consultation, in addition to surgery consultation, is required if:
- Periurethral abscess is inciting event
- Infection has secondarily invaded the urinary tract and a suprapubic catheter is needed
See Also
References
- ↑ Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.