SCROTAL ABNORMALITIES-FOURNIERS GANGRENE

Question 1

Necrotizing fasciitis (polymicrobial infection) of the subcutaneous tissues of the perineum often involving the scrotum. 
(b) Typically begins as a benign infection or simple abscess that quickly leading to widespread necrosis of otherwise previously healthy tissue

Answer 1

Fournier’s Gangrene

Question 2

Signs and symptoms of Fournier’s Gangrene

Answer 2

(a) Tense edema of scrotum and other involved skin
(b) Blisters/bullae
(c) Crepitus
(d) Fever
(e) Pain (out of proportion to physical exam)
(f) Tachycardia
(g) Hypotension

Question 3

Imaging of Fournier’s Gangrene

Answer 3

(a) CT and MRI
1) May show air along the fascial planes or deeper tissue involvement.
2) Imaging studies should not delay surgical exploration when there is clinical evidence of progressive soft tissue infection.

Question 4

Treatment of Fournier’s Gangrene

Answer 4

(a) Aggressive surgical exploration and debridement
(b) Broad spectrum antibiotics (gram- positive, gram-negative and anaerobic coverage)
1) Ertapenem (Invanz) - Carbapenem antibiotic
(c) Fluid resuscitation
(d) MEDEVAC

Question 5

Complications of Fournier’s Gangrene

Answer 5

(a) Patients may ultimately require
1) Cystostomy
2) Colostomy
3) Orchiectomy

Question 6

Follow up of Fournier’s Gangrene

Answer 6

(a) Urologic consultation is often required when periurethral abscess is the inciting event or if the gangrene has invaded the urinary tract.