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
- Diabetes mellitus
- Hypertension
- Alcoholism
- Advanced age
- Para/Quadriplegic
- Under diagnosed in women[1]
- Mortality
- Most often 20-40%, but ranges from 4% to 80%[2]
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