Fournier's gangrene

Question 1

What is Fournier’s gangrene?

Answer 1

A type of necrotising fasciitis that affects the perineum due to infection. This is a urological emergency.

Question 2

What are risk factors for fournier’s gangrene?

Answer 2

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

Question 3

How does fournier’s gangrene present?

Answer 3

• severe pain
• pyrexia
• skin necrosis
• crepitus
• haemorrhagic bullae
• sensory loss of overlying skin
• rapidly deteriorate.
• sepsis / septic shock

Question 4

What is the main differential in early stages of Fournier’s gangrene?

Answer 4

Cellulitis

Question 5

How is fournier’s gangrene managed?

Answer 5

Urgent surgical debridement - normally partial or total orchiectomy (removal of the testicles)
Broad spectrum antibiotics
Fluid resus + close monitoring
Urethral assessment

• further plastic surgery may be needed - including closure with skin grafts etc.

Question 6

What is an orchiectomy?

Answer 6

Surgical removal of the testicles