Fournier gangrene: Difference between revisions
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==Background== | ==Background== | ||
*Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area. | *Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area. | ||
**Mostly bacteria lower GI system - B. fragilis and E. coli | |||
**Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin<ref name="Shyam">Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon. 2013 Aug;11(4):222-32. doi: 10.1016/j.surge.2013.02.001.</ref> | **Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin<ref name="Shyam">Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon. 2013 Aug;11(4):222-32. doi: 10.1016/j.surge.2013.02.001.</ref> | ||
*Risk Factors | *Risk Factors | ||
Revision as of 00:19, 12 December 2015
Background
- Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.
- Mostly bacteria lower GI system - B. fragilis and E. coli
- Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin[1]
- Risk Factors
- Diabetes mellitus (most common)
- Hypertension
- Alcoholism
- Advanced age
- Para/Quadriplegic
- M>F (10:1)[1], (likely under-diagnosed in women[2])
- Mortality - often cited as 20-40%, but up to 80% in some studies[2]
Clinical Features
- Initial event is usually local trauma or extension of a UTI or perianal infection[1]
- Gangrene develops over 2-7 days
- Marked pain, localized swelling, crepitus, ecchymosis to genital or perineal area.
- Fever
- Malodorous purulent drainage
- In late or severe cases, pt may present in septic shock
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
Work-up
- CBC
- CMP
- CRP
- Lactate
- Type and Screen
- Wound Culture
- Blood Cultures
- CT Abdomen/pelvis (only if diagnosis unclear or if requested by surgery/urology)
Evaluation
- Clinical diagnosis, based on history and physical exam
Treatment
- Immediate surgery and urology consult for surgical debridement (gangrene can spread at rate of 2-3 cm/hr[1])
- Antibiotics - Must cover gram positive, gram negative, and anaerobes
- Vancomycin + (imipenem 1gm IV q24hr OR meropenem 500mg-1gm IV q8hr)
- Aggressive supportive care, including fluid resuscitation (and pressors, if indicated)
Disposition
- Admit to ICU