Fournier

1
Fourniers Gangrene

• AM Report
• 9/17/08
• Lisa Rose-Jones

2
Necrotizing Fasciitis

• Type 1
• -mixed aerobic and anaerobic bacteria
• -usually after surgical procedures
• -in diabetics and pts with w/ PVD
• Type 2
• -monomicrobial, typically caused by Group A strep
  or MRSA
• -typically no comorbidities
• -expGAS fasciitis after chickenpox

3
Fourniers Fasciitis

• Classified as a Type 1, this represents an
  aggressive infection of perineal area
• Originally described in 1764, but bears the name
  of Jean-Alfred Fournier, a Parisian
  venereologist, who lectured on this in the late
  1800s

4
Fourniers Fasciitis

• Men are 10x more likely than women to have this
• (few incidences in women associated with septic
  abortions, episiotomy, or hysterectomy)
• Most susceptible are men 60-80 yo
• Only 1726 in literature from 1950-1999

5
Causes

• Penetration of the GI (diverticulitis,
  appendicits) or urethral (UTI) mucosa by enteric
  organisms
• Local trauma
• Dermatologic hidradenitis suppurativa,
  ulceration from scrotal pressure

6
Common Culprits(on avg there are 4 isolates)

• E. Coli
• Bacteroides
• Others Proteus, Enterococcus, Staphylococcus,
  Klebsiella, Streptococcus, Pseudomonas, and
  Clostridium
• Yeast

7
Comorbid Diseases

• DM
• Vascular Disease
• Malignancies
• Cirrhosis
• Morbid Obesity
• Immune Suppression from systemic disease or
  steroid treatment
• described as a necessary predisposing factor

8
THE SIGNS!!

• Discomfort of the genitalia
• Skin may be spongy, erythematous, indurated,
  edematous, or normal
• often underestimates degree of underlying
  disease
• Early pain may be out of proportion to exam,
  however may subside later in course as nerve
  tissue become necrotic!

9
Diagnosis

• Diagnosis based usually on clinical findings and
  a strong suspicion from laboratory data (high
  WBC, ESR, CRP, etc)
• Sensitivity and Specificity of different
  radiologic studies have not been well
  established, though CT is fast and can well
  define the extent of the disease

10
Treatment

• Urological Emergency!! Typically multiple
  debridements.
• Early broad spectrum Antibiotics
• Aggressive Management of Sepsis if present
• Diversion of urine and stool are sometimes
  necessary
• Hyperbaric Oxygen Therapy

11
References

• Eke N. Fournier's gangrene a review of 1726
  cases. Br J Surg. Jun 200087(6)718-28.
• Yeniyol CO, Suelozgen T, Arslan M, Ayder
  AR. Fournier's
• gangrene experience with 25 patients and use
  of Fournier's gangrene severity index
  score. Urology. Aug 200464(2)218-22
• Stevens, D. Necrotizing infections of the skin
  and fascia UpToDate Online. Last updated on May
  31, 2008.
• Eyre, R. Evaluation of the acute scrotum in
  adults UpToDate Online. Last updated on May 31,
  2008.