Fournier gangrene
Background
- Polymicrobial necrotizing fasciitis of perineal, genital, or perianal anatomy
- Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin
- Risk factors = DM, alcohol abuse
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
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
- Necrotizing Fasciitis
- [{Testicular Pain]]
Source
Tintinalli