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Fournier's gangrene
Last reviewed: 04.07.2025
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Causes of Fournier's gangrene
There is no consensus on the etiology and pathogenesis of necrotizing fasciitis of the genitals.
When examining the discharge from the wound, Staphylococcus aureus, hemolytic streptococcus in associations, Escherichia coli, Enterococcus, and Proteus are detected. Studies of the culture obtained from the wound confirm anaerobic-aerobic associations in a third of observations.
Mixed cultures containing facultative organisms (E. coli, Klebsiella, Enterococcus) along with anaerobes (Bacteroides, Fusobacterium, Clostridium, Microaerophilic streptococcus).
Pathogenesis
In the pathogenesis of Fournier's gangrene, the main role is played by developing thrombosis of the vessels of the scrotum and penis. This contributes to the extremely rapid development of multiple thrombophlebitis and, as a consequence, edema of the cellular tissue, development of tissue ischemia, thrombosis and bacterial embolism. The outcome of the disease is necrosis of the genitals.
Much attention is paid to factors that contribute to the development of the disease. These include recent trauma to the perineum, dysuria after sexual intercourse, urinary fistulas, pain during defecation, rectal bleeding, and anal fissures in the anamnesis. Acute chronic inflammation of the scrotum and balanoposthitis indicate the possibility of a cutaneous source of infection. The risk of developing the disease is increased with septicopyemia, diabetes mellitus, intoxication, corticosteroid therapy, and alcoholism.
When making a diagnosis, the degree of damage and possible complications (sepsis, peritonitis) are indicated.
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Symptoms of Fournier's gangrene
The symptoms of Fournier's gangrene are characteristic and typical, the disease develops rapidly, which does not cause any particular difficulties in establishing a diagnosis. The infection begins as cellulitis (inflammation of the subcutaneous tissue), first swelling and hyperemia appear, then the infection spreads to the underlying areas. Pain, hyperthermia, and general intoxication appear. Swelling and crepitus of the scrotum quickly increase, hyperemia turns into merging foci of dark purple ischemia, where extensive gangrene develops. Involvement of the anterior abdominal wall is possible (in diabetes mellitus and obesity).
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Treatment of Fournier's gangrene
Bacteriological testing helps to adjust antibacterial therapy, especially when complications develop.
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Drug treatment of Fournier's gangrene
When hospitalized, it is necessary to prescribe broad-spectrum antibacterial drugs from the moment the diagnosis is established.
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Surgical treatment of Fournier's gangrene
Early surgical treatment of Fournier's gangrene - necrectomy, strip incisions of the skin and underlying tissues in the area of the gangrenous process, opening and drainage of abscesses and phlegmons.
The use of heparin and extracorporeal detoxification methods, hyperbaric oxygenation can speed up recovery.
Repeated surgical interventions are performed after 6-8 months to correct cosmetic defects formed after wound healing by secondary intention, with the formation of coarse scars.