Fournier's Gangrene

Question 1

What is Fournier’s Gangrene?

Answer 1

• necrotising fasciitis that affects the perineum

*NEUROLOGICAL EMERGENCY

Question 2

What are the causative organisms for FG?

Answer 2

• Group A streptococcus (S. Pyogenes)
• C. Perfringes
• E. Coli.

Question 3

What are the anatomical barriers to the spread of infection in the scrotum?

Answer 3

• dartos fascia of the penis and scrotum
• Colles fascia of the perineum
• Scarpa fascia of the anterior abdominal wall.

Question 4

What are the RF of FG?

Answer 4

• Diabetes mellitus
• Excess alcohol
• Poor nutritional state
• Steroid use
• Haematological malignancies
• Recent trauma to the region

Question 5

What are the clinical features of FG?

Answer 5

Early stage:

• severe pain, out of proportion to clinical signs
• pyrexia

Later on:

• crepitus
• skin necrosis
• haemorrhagic bullae
• Sensory loss of the overlying skin
• Septic shock

Question 6

What are the differential diagnosis for FG?

Answer 6

• cellulitis
• epididimyo orchitis
• testicular torsion

Question 7

What ix would you order for FG?

Answer 7

Clincally diagnosed. Send pt for surgical exploration if suspected

• routine bloods
• blood cultures
• CT imaging
  
  • fascial swelling
  • soft tissue gas

Question 8

What scoring system is used to aid diagnosis fo Nec Fasc and FG?

Answer 8

• Laboratory Risk Indicator for Necrotising Fascitis (LRINEC)

Question 9

Describe the LRINEC score

Answer 9

• ≥6 is a reasonable score to consider the diagnosis based on lab results alone

Question 10

What are the parameters meseaured in PRINEC?

Answer 10

• CRP
• WCC
• Hb
• Na
• Cr
• Glucose

Question 11

How would you mx FG?

Answer 11

• urgent surgical debridement
• partial/total orchiectomy
• broad spec abx
• ICU