Fournier Gangrene

Question 1

Definition

Answer 1

Nec Fas of the peritoneum and genital region frequently due to synergistic polymicrobial infection

Question 2

Risk Factors

Answer 2

Diabetes, Alcoholics, Immunocomprised

Question 3

Pathophysiology

Answer 3

GU - urethral stones/stricture/fistula
Colorectal - ruptured appendictis, colonic CA, diverticulitis, perirectal abscess
Dermatological
Idiopathic

Question 4

Clinical Presentation

Answer 4

-History-
1. Abrupt onset with pruritis, rapidly progressing to edema, erythema and necrosis within hours of the scrotum, phallus and perianal area
2. Fever, perineal and scrotal pain and associated indurated tissue
3. Crepitus in tissue (suggest presence of gas-forming organisms)
4. Pain out of proportion to physical findings

Question 5

Management

Answer 5

1. Broad Spectrum Abx
   - IV penicillin
   - IV ceftazidime
   - IV clindamycin
2. Wide debridement with aggressive postoperative support
3. Colostomy if damage to external anal sphincter
4. Tight glucose control and adequate nutrition (to facilitate wound healing)