|
|
| (328 intermediate revisions by 7 users not shown) |
| Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | '''For more information about necrotizing fasciitis click [[necrotizing fasciitis|here]] |
| | '''For patient information, click [[Fournier gangrene (patient information)|here]]''' |
| | {{Fournier gangrene}} |
| {{SCC}}; {{AE}} {{YK}}; {{JH}} | | {{SCC}}; {{AE}} {{YK}}; {{JH}} |
|
| |
|
| {{SK}} Idiopathic gangrene of scrotum; Periurethral phlegmon; Streptococcal scrotal gangrene | | {{SK}} Fournier's gangrene; Idiopathic gangrene of scrotum; Periurethral phlegmon; Streptococcal scrotal gangrene; Genito-perineal gangrene; Phagedena |
|
| |
|
| {{Search infobox}} | | {{Search infobox}} |
| Line 19: |
Line 21: |
| | MeshID = D018934 | | | MeshID = D018934 |
| }} | | }} |
| | ==[[Fournier gangrene overview|Overview]]== |
|
| |
|
| ==Overview== | | ==[[Fournier gangrene historical perspective|Historical Perspective]]== |
| '''Fournier gangrene''' is a type of [[necrosis|necrotizing]] [[infection]] ([[gangrene]]) of the perineal, genital or perianal regions usually affecting the male [[genital]]s but can also occur in female and children.<ref name="pmid9523650">{{cite journal| author=Smith GL, Bunker CB, Dinneen MD| title=Fournier's gangrene. | journal=Br J Urol | year= 1998 | volume= 81 | issue= 3 | pages= 347-55 | pmid=9523650 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9523650 }} </ref> It is a fulminant form of [[necrotizing fasciitis]]. It was first described by Baurienne in 1764 and is named after a French [[venereology|venereologist]], Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883.<ref name="pmid9492752">{{cite journal| author=Nathan B| title=Fournier's gangrene: a historical vignette. | journal=Can J Surg | year= 1998 | volume= 41 | issue= 1 | pages= 72 | pmid=9492752 | doi= | pmc=3950066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9492752 }} </ref><ref name="pmid26445600">{{cite journal| author=Chennamsetty A, Khourdaji I, Burks F, Killinger KA| title=Contemporary diagnosis and management of Fournier's gangrene. | journal=Ther Adv Urol | year= 2015 | volume= 7 | issue= 4 | pages= 203-15 | pmid=26445600 | doi=10.1177/1756287215584740 | pmc=4580094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26445600 }} </ref>
| |
|
| |
|
| ==Historical Perspective== | | ==[[Fournier gangrene classification scheme|Classification]]== |
| *Fournier's gangrene was first described by in 1764 by Baurienne.<ref name="pmid9492752">{{cite journal| author=Nathan B| title=Fournier's gangrene: a historical vignette. | journal=Can J Surg | year= 1998 | volume= 41 | issue= 1 | pages= 72 | pmid=9492752 | doi= | pmc=3950066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9492752 }} </ref>
| |
| *The detailed description of fournier's gangrene was given by Jean Alfred Fournier, who is a French venereologist in 1883.<ref name="pmid26445600">{{cite journal| author=Chennamsetty A, Khourdaji I, Burks F, Killinger KA| title=Contemporary diagnosis and management of Fournier's gangrene. | journal=Ther Adv Urol | year= 2015 | volume= 7 | issue= 4 | pages= 203-15 | pmid=26445600 | doi=10.1177/1756287215584740 | pmc=4580094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26445600 }} </ref>
| |
|
| |
|
| ==Classification== | | ==[[Fournier gangrene pathophysiology|Pathophysiology]]== |
|
| |
|
| ==Pathophysiology== | | ==[[Fournier gangrene causes|Causes]]== |
| ===Pathogenesis===
| |
| ===Common locations===
| |
|
| |
|
| ===Microscopic histopathological analysis=== | | ==[[Differentiating Fournier gangrene from other diseases|Differentiating Fournier gangrene from other Diseases]]== |
|
| |
|
| ==Causes== | | ==[[Fournier gangrene epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Aetiology===
| |
| In the majority of cases Fournier gangrene is a mixed infection caused by both [[aerobic]] and [[anaerobic]] bacteria.<ref>{{cite journal |author=Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K |title=Fournier's gangrene and its emergency management |journal=Postgrad Med J |volume=82 |issue=970 |pages=516-9 |year=2006 |id=PMID 16891442}}</ref>
| |
|
| |
|
| ==Differentiating {{PAGENAME}} from Other Diseases== | | ==[[Fournier gangrene risk factors|Risk Factors]]== |
|
| |
|
| ==Epidemiology and Demographics== | | ==[[Fournier gangrene screening|Screening]]== |
| ===Incidence===
| |
| Only 600 cases of Fournier gangrene were reported in the world literature in the ten years since 1996, with most patients in their 60s or 70s with other concurrent illnesses.<ref>{{cite journal |author=Vaz I |title=Fournier gangrene |journal=Trop Doct |volume=36 |issue=4 |pages=203-4 |year=2006 |id=PMID 17034687}}</ref> However, Fournier's gangrene is not a reportable illness, and the condition is not uncommon, especially among diabetic individuals. A similar infection in women has been occasionally described.<ref>{{cite journal |author=Herzog W |title=[Fournier gangrene--also in females?] |journal=Zentralbl Chir |volume=112 |issue=9 |pages=564-76 |year=1987 |id=PMID 2956804}} </ref>
| |
|
| |
|
| In Turkey it was reported that 46% of patients had [[diabetes mellitus]]<ref name="Yanar2006">{{cite journal |author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I |title=Fournier's gangrene: risk factors and strategies for management |journal=World J Surg |volume=30 |issue=9 |pages=1750-4 |year=2006 |id=PMID 16927060}}</ref> whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).<ref>{{cite journal |author=Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O |title=Fournier's gangrene: report of thirty-three cases and a review of the literature |journal=Int J Urol |volume=13 |issue=7 |pages=960-7 |year=2006 |id=PMID 16882063}}</ref>
| | ==[[Fournier gangrene natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| | |
| ===Age===
| |
| | |
| ===Gender===
| |
| | |
| ==Risk Factors==
| |
| Common risk factors in the development of fournier's gangrene are:<ref name="pmid2294630">{{cite journal| author=Clayton MD, Fowler JE, Sharifi R, Pearl RK| title=Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. | journal=Surg Gynecol Obstet | year= 1990 | volume= 170 | issue= 1 | pages= 49-55 | pmid=2294630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2294630 }} </ref><ref name="pmid12516849">{{cite journal| author=Morpurgo E, Galandiuk S| title=Fournier's gangrene. | journal=Surg Clin North Am | year= 2002 | volume= 82 | issue= 6 | pages= 1213-24 | pmid=12516849 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12516849 }} </ref><ref name="pmid10584624">{{cite journal| author=Vick R, Carson CC| title=Fournier's disease. | journal=Urol Clin North Am | year= 1999 | volume= 26 | issue= 4 | pages= 841-9 | pmid=10584624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10584624 }} </ref>
| |
| *Comorbid systemic disorders
| |
| :*Age>50 yrs
| |
| :*Male Gender
| |
| :*Diabetes mellitus
| |
| :*Alcohol misuse
| |
| :*Immunosupression
| |
| :*Chemotherapy
| |
| :*Chronic corticosteroid use
| |
| :*HIV
| |
| :*Leukemia
| |
| :*Liver disease
| |
| :*Debilitating illness
| |
| :*Malignancy
| |
| :*Cytotoxic drugs
| |
| The most common foci of fournier's gangrene include:<ref name="pmid10848848">{{cite journal| author=Eke N| title=Fournier's gangrene: a review of 1726 cases. | journal=Br J Surg | year= 2000 | volume= 87 | issue= 6 | pages= 718-28 | pmid=10848848 | doi=10.1046/j.1365-2168.2000.01497.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10848848 }} </ref><ref name="pmid7950832">{{cite journal| author=Amendola MA, Casillas J, Joseph R, Antun R, Galindez O| title=Fournier's gangrene: CT findings. | journal=Abdom Imaging | year= 1994 | volume= 19 | issue= 5 | pages= 471-4 | pmid=7950832 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7950832 }} </ref>
| |
| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| |
| |+
| |
| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Anorectal}}
| |
| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Genitourinary}}
| |
| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Dermatology}}
| |
| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Gynaecological}}
| |
| |-
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Trauma<br>
| |
| *Steroid enemas for radiation proctitis<br>
| |
| *Hemorrhoidectomy<br>
| |
| *Anal fissures excision<br>
| |
| *Diverticulitis<br>
| |
| *Colonic perforations<br>
| |
| *Ischiorectal, perirectal, or perianal abscesses<br>
| |
| *Appendicitis<br>
| |
| *Steroid enemas for radiation proctitis
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Trauma<br>
| |
| *Cancer invasion to external genitalia<br>
| |
| *Hemipelvectomy<br>
| |
| *Epididymitis or orchitis<br>
| |
| *Penile artificial implant or a foreign body<br>
| |
| *Hydrocele aspiration<br>
| |
| *Genital piercing<br>
| |
| *Intracavernosal cocaine<br>
| |
| *Urethral catheterization or instrumentation<br>
| |
| *Penile implantsinsertion<br>Prostatic biopsy<br>
| |
| *Vasectomy<br>
| |
| *Urethral strictures with urinary extravasation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Blunt perineal trauma<br>
| |
| *Intramuscular injections<br>
| |
| *Genital piercings<br>
| |
| *Scrotal furuncle<br>
| |
| *Perineal or pelvic surgery/inguinal herniography<br>
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Episiotomy wound<br>
| |
| *Infected bartholins gland<br>
| |
| *Septic abortion<br>
| |
| *Genital mutilation<br>
| |
| *Coital injury
| |
| |}
| |
| | |
| ==Screening==
| |
| | |
| ==Natural History, Complications, and Prognosis==
| |
|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| ===Diagnostic Criteria===
| | [[Fournier gangrene diagnostic criteria|Diagnostic criteria]] | [[Fournier gangrene history and symptoms|History and Symptoms]] | [[Fournier gangrene physical examination|Physical Examination]] | [[Fournier gangrene laboratory tests|Laboratory Findings]] | [[Fournier gangrene electrocardiogram|Electrocardiogram]] | [[Fournier gangrene x ray|X-Ray Findings]] | [[Fournier gangrene CT|CT-Scan Findings]] | [[Fournier gangrene MRI|MRI Findings]] | [[Fournier gangrene ultrasound or echocardiography|Echocardiography and Ultrasound]] | [[Fournier gangrene other diagnostic studies|Other Diagnostic Studies]] | [[Fournier gangrene other imaging findings|Other Imaging Findings]] |
| | |
| ===History and Symptoms===
| |
| | |
| | |
| ===Physical examination===
| |
| ====Gallery====
| |
| =====Genitourinary system=====
| |
| | |
| <gallery>
| |
| | |
| Image: Fournier's_gangrene_01.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
| |
| | |
| Image: Fournier's_gangrene_02.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
| |
| | |
| Image: Fournier's_gangrene_03.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
| |
| | |
| Image: Fournier's_gangrene_04.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
| |
| | |
| Image: Fournier's_gangrene_05.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
| |
| | |
| </gallery>
| |
| | |
| ===Laboratory Findings===
| |
| | |
| ===Imaging Findings===
| |
| | |
| ===Other Diagnostic Studies===
| |
|
| |
|
| ==Treatment== | | ==Treatment== |
| ===Medical Therapy===
| | [[Fournier gangrene medical therapy|Medical Therapy]] | [[Fournier gangrene surgery|Surgery]] | [[Fournier gangrene primary prevention|Primary Prevention]] | [[Fournier gangrene secondary prevention|Secondary Prevention]] | [[Fournier gangrene cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Fournier gangrene future or investigational therapies|Future or Investigational Therapies]] |
| Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="Yanar2006"/>
| |
| ====Antimicrobial Therapy====
| |
| * Fournier gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
| |
| :* '''If caused by streptococcus species or clostridia'''
| |
| ::* Preferred regimen: [[Penicillin G]]
| |
| :* '''Polymicrobial'''
| |
| | |
| ::* Preferred regimen: [[Doripenem]] {{or}} [[imipenem]] {{or}} [[meropenem]]
| |
| :* '''MRSA (methicillin resistant staphylococcus aureus) suspected'''
| |
| | |
| ::* Preferred regimen: [[vancomycin]] {{or}} [[daptomycin]]
| |
| | |
| ===Surgery===
| |
| | |
| ===Prevention===
| |
|
| |
|
| ==External links== | | ==Case Studies== |
| * {{WhoNamedIt2|synd|2521|Fournier gangrene}} and {{WhoNamedIt|doctor|2209|Jean Alfred Fournier}}
| | [[Fournier gangrene case study one|Case #1]] |
| | | [[Category:Emergency mdicine]] |
| ==References==
| | [[Category:Disease]] |
| {{reflist|2}}
| |
|
| |
|
| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |
| | [[Category:Surgery]] |
| | [[Category:Orthopedics]] |
| [[Category:Dermatology]] | | [[Category:Dermatology]] |
|
| |
| {{WH}}
| |
| {{WS}}
| |