What is Fournier’s Gangrene?
Gangrene is a medical term used to describe necrosis of tissues or death of tissues due to poor blood supply or bacterial infection. Fournier’s gangrene mainly affects males and is characterised by infection in male genital area which includes scrotum, testicles, penis or perineum. In advanced cases, the infection may spread to adjacent areas such as thighs, stomach and even chest in some cases. There is growth of multiple organisms which leads to severe infection in the genital area. This condition is rare but it is considered as a medical emergency when diagnosed. In extreme cases, the condition is life threatening and can spread rapidly. There may be death of soft tissues, including muscles, nerves and blood vessels due to necrotising fasciitis. It may be required to remove the infected tissues such as partial or complete removal of penis or testicles and other surrounding areas.
Symptoms of Fournier’s Gangrene
Fournier’s gangrene often begins with generalized feeling of being unwell. The most commonly encountered symptoms are:
- Malaise
- Pain and discomfort in the genital area
- Swelling and inflammation in the genital area.
As the condition worsens, the pain and discomfort in the genital areas worsens and becomes unbearable. There is foul smell in the area due to tissue necrosis (death of the tissue). The skin over the affected area may rub over each other causing friction creating a crackling sound called as crepitus.
Fournier’s gangrene is characterized by cascade of symptoms as mentioned below:
- Presence of infection which worsens over time.
- Spread of infection to the deeper tissues causing inflammation of blood vessel linings. This is also known as endarteritis.
- The inflammation gradually leads to blood clot formation. The tissues lose blood supply and begin to undergo necrosis.
- Release of toxic material and by products of necrotic tissue in the blood stream by the action of bacteria and other pathogens. This leads to inflammatory response in the body because of which the body is unable to maintain blood pressure and the organs begin to dysfunction. Death may be the end result due to septic shock.
- It is advised to seek medical treatment at the earliest to avoid serious life threatening complications.
Causes of Fournier’s Gangrene
The most common cause of Fournier’s gangrene is infection. In most of the cases, there is a skin wound which does not heal and provides a channel for bacteria, viruses and fungi to reach deeper portion of the skin causing damage. The most common sources of these infections are:
- Urinary tract infections
- Hysterectomies
- Bladder infections
- Anorectal abscesses and other abscesses in the genital areas
- Circumcision
- Insect bites
- Burns
- Surgical incisions
- Rectal cancer
- Genital piercings
- Diverticulitis.
Risk Factors of Fournier’s Gangrene
In some cases, the exact source of gangrene cannot be identified. However, a list of predisposing risk factors have been identified which are mentioned below:
- History of diabetes
- History of alcoholism
- Trauma to genital area
- Steroids
- Chemotherapy
- Liver disease such as cirrhosis
- Weight gain and morbid obesity
- Immunocompromised state such as HIV.
Studies have shown that about 20 to 70 percent of patients affected by Fournier’s gangrene have a known history of diabetes; and about 25 to 50 percent of them are known to have alcohol or substance abuse disorder.
Prevalence of Fournier’s Gangrene
As mentioned earlier, Fournier’s gangrene is more common in men, but can affect women and children very rarely. It commonly affects men between the ages of 50 to 60 years. Statistically speaking, men are 10 times more likely to be affected by this condition. In general, Fournier’s gangrene is very rare and it is even rarer in women and rarest in children.
Diagnosis of Fournier’s Gangrene
Diagnosis of Fournier’s gangrene involves obtaining detailed case history followed by physical examination of the area. Specialized studies such as ultrasonography are often helpful to study the inflammation, gases and fluids in the area. Tests are done to rule out other causes of similar symptoms such as epididymitis and orchitis. CT (computerized tomography) scans and x-rays are also helpful in reaching correct diagnosis. Blood work is done to evaluate the cause of the infection and also for determining the clotting abilities.
Treatment of Fournier’s Gangrene
Upon diagnosis, treatment should be started as soon as possible. Treatment modality involves immediate administration of strong antibiotics (mostly through IV route) to kill the causative organisms and arrest the spread of infection. In most of the cases, surgical debridement may be necessary for cleaning the affected skin and removal of the dead tissues. It is necessary to remove enough tissue to ensure the infection does not spread to the adjacent areas. In some cases, multiple sessions of debridement may be required.
Hyperbaric oxygen therapy is often helpful in this condition. It is a procedure where the body is exposed to 100 percent oxygen under controlled environment. This prevents growth of bacteria, promotes wound healing and reverses the damage in blood vessels.
Surgical removal of affected organ and reconstruction may be required if all other treatment fails. Skin grafting and plastic surgery is often used for reconstruction.
Prognosis of Fournier’s Gangrene
It has been noted that hospital admission for Fournier’s gangrene is rare. Only 0.02 percent of cases are known to be hospitalized. Studies have shown that 20 to 40 percent of patients suffering from this condition die secondary to serious complications. The prognosis in older population is worse than that in younger population. It is advised to seek help at the earliest without any hesitation to avoid complications.
Prevention of Fournier’s Gangrene
Early diagnosis and early treatment is the key factor for preventing complications in this condition. Besides this, few other precautions have to be taken as mentioned below:
- In case of diabetes, it is advised to examine the genital areas on a regular basis and check for any wounds, drainage, swelling or signs of infection.
- Obese individuals should work hard to lose weight and follow a healthy lifestyle.
- Limit alcohol intake and quit smoking. These are known to have adverse effects on the health of blood vessels and this should be avoided.
- Wounds should be kept sterile and care should be taken to avoid any infection in them. Delayed healing and recurrence should be reported immediately.
Conclusion
Fournier’s gangrene can be managed and treated with proper medication. If the infection has progressed, surgery might be needed. A proper timely management can heal the infection; however, if neglected, the condition can progress to life threatening situation. If symptoms of Fournier’s gangrene are noted, one must seek medical help immediately.
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