Gangrene Furnier

Necrotizing fasciitis of the genital organs (Fournier gangrene) - idiopathic scrotal gangrene, streptococcal scrotal gangrene, perineal phlegmon and lightning scrotal gangrene, scrotal gangrenous erysipelas, anaerobic scrotal phlegmon.

[1], [2]

Causes of the fourier's gangrenes

There is no consensus on the etiology and pathogenesis of genital necrotizing fasciitis.

In the study of discharge from the wound found Staphylococcus aureus, hemolytic streptococcus in associations, E. Coli enterococcus, Proteus. Studies of the culture obtained from the wound, a third of observations confirm anaerobic-aerobic associations.

Mixed cultures containing optional organisms (E. Coli, Klebsiella, Enterococcus) attire) with anaerobes (Bacteroides, Fusobacterium, Clostridium, Microaerophilic streptococcus).

[3], [4], [5], [6],

Pathogenesis

In the pathogenesis of the Fournier gangrene disease, developing thrombosis of the scrotum and penis vessels is of primary importance. This contributes to the extremely rapid development of multiple thrombophlebitis and, as a consequence, cellulose edema, development of tissue ischemia, thrombosis and bacterial embolism. The outcome of the disease is genital necrosis.

Great attention is paid to factors contributing to the occurrence of the disease. These include recent trauma of the perineum, dysuria after intercourse, urinary fistula, pain during bowel movements, rectal bleeding, anal fissures in history. The possibility of a skin source of infection is indicated by acute chronic inflammation of the scrotum, balanoposthitis. Increased risk of developing the disease with septicopyemia, diabetes, intoxication, corticosteroid therapy, alcoholism.

When making a diagnosis, indicate the degree of damage, possible complications (sepsis, peritonitis).

[7]

Symptoms of the fourier's gangrenes

The symptoms of Fournier's gangrene are characteristic and typical, the disease develops rapidly, which does not cause special difficulties in establishing the diagnosis. Infection begins as cellulitis (inflammation of the subcutaneous tissue), edema and hyperemia first appear, then the infection spreads to the underlying areas. There is pain, hyperthermia, general intoxication. The edema and crepitus of the scrotum rapidly increase, the hyperemia passes into the confluent foci of ischemia of dark-purple color, where extensive gangrene develops. Possible involvement of the anterior abdominal wall (with diabetes and obesity).

[8], [9], [10], [11], [12], [13], [14]

Treatment of the fourier's gangrenes

Bacteriological research helps to correct antibacterial therapy, especially with the development of complications.

[15], [16], [17], [18], [19]

Drug treatment of Fournier's gangrene

At hospitalization, it is necessary to prescribe a broad-spectrum antibacterial drugs from the time of diagnosis.

[20]

Surgical treatment of Fournier's gangrene

Early surgical treatment of Fournier's gangrene - necrotomy, lumbar incisions of the skin and underlying tissues in the area of the gangrenous process, dissection and drainage of abscesses and phlegmon.

The use of heparin and methods of extracorporeal detoxification, hyperbaric oxygenation can speed recovery.

Repeated surgery carried out after 6-8 months, for the correction of cosmetic defects formed after wound healing by secondary intention, with the formation of coarse scars.

[21], [22]

Forecast

Fournier's gangrene directly depends on the time of treatment, concomitant diseases, and equipment of the clinic. Mortality in the disease, according to different authors, varies from 7 to 42%.

[23], [24]