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What is Fournier's Gangrene?

Fournier gangrene is a serious, rapidly progressive infective gangrene involving the scrotum, penis, and/or perineum caused by a broad array of microorganisms, acting in mutual support of one another (synergistically) and usually resulting from local trauma, operative procedures, or urinary tract disease. Since 1950, more than 1,800 cases for study have been reported in English language medical literature. This disease occurs worldwide and, although it is recognized more frequently among male adults, has been identified also among women and children. Treatment usually consists of the surgical removal (debridement) of extensive areas of dead tissue (necrosis, necrotic) and the administration of broad-spectrum intravenous antibiotics. Surgical reconstruction may follow where necessary. Definition of Fournier's gangrene

Fournier's gangrene: A horrendous infection of the genitalia that causes severe pain in the genital area (in the penis and scrotum or perineum) and progresses from erythema (redness) to necrosis (death) of tissue. Gangrene can occur within hours. The mortality (death) rates are up to 50%.

In this major medical emergency, a bacterial infection spreads quickly from the urinary tract (or the perianal, abdominal, or retroperitoneal areas), often following trauma. The gangrene is due to thrombosis of small blood vessels below the skin.

Fornier's gangrene has been thought to strike mainly men over 50. Today the disease is not limited to older males or to men (although women are less commonly affected than men). Fourier's gangrene can also occur in children from infancy to adolescence following such events as insect bites, trauma, burns, perirectal diseases and infections. Predisposing factors in all age ranges include diabetes, immunodeficiency and corticosteroid use.

Treatment is urgent. It involves surgically cutting away (debriding) the infected and necrotic (dead) tissue. Depending on the extent of the infection, surgical exploration of the abdomen and a colostomy also may be necessary. Triple-drug antibiotic therapy is given with, for example, Flagyl (metronidazole), ampicillin, and gentamicin.

The syndrome is named for Jean Alfred Fournier, a French venereologist (venereal disease specialist), who first described it in 1883.

Fournier's gangrene is a serious, life-threatening infection of the male genital area. The infection usually starts in the skin of the genitals (penis or scrotum), the urethra, or the rectal area.

There are several conditions that may lead to this infection. Frequently an injury or burn to the area occurred before the infection. Genital surgery, a sexually transmitted infection (STI), or a problem with the urethra also may precede this infection. Men with certain conditions are at higher risk for developing Fournier's gangrene. These conditions include:

Being older than age 50.
Having diabetes.
Having a suppressed immune system.
Symptoms include:
Swelling and redness.
Tissue that looks deeply bruised but is actually dead (necrotic).
Drainage of pus with a bad odor.
Pain.
Fever.
Pain with urination.
Problems passing urine.
Possible shock.

This infection is a medical emergency. It is treated with antibiotics, and surgery is usually needed to remove dead (necrotic) tissue.

In my experience in Kenya I have seen 4 cases of Fournier’s gangrene over a 20 year period. It one of the most memorable visual perceptions in medical practice

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