Fournier gangrene natural history, complications and prognosis: Difference between revisions

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==Overview==
==Overview==
If left untreated, the acute inflammatory changes spread quickly, accompanied by [[high fever]] and extreme weakness.<ref name="pmid20542593">{{cite journal| author=Morgan MS| title=Diagnosis and management of necrotising fasciitis: a multiparametric approach. | journal=J Hosp Infect | year= 2010 | volume= 75 | issue= 4 | pages= 249-57 | pmid=20542593 | doi=10.1016/j.jhin.2010.01.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20542593  }} </ref><ref name="pmid8436051">{{cite journal| author=Ecker KW, Derouet H, Omlor G, Mast GJ| title=[Fournier's gangrene]. | journal=Chirurg | year= 1993 | volume= 64 | issue= 1 | pages= 58-62 | pmid=8436051 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8436051  }}</ref> The overlying skin becomes smooth, tense and shiny and diffuse [[erythema]] without distinct borders are seen. During the first 1 or 2 days, the lesions develop with progressive color changes from red to purple to blue and then become [[gangrene|gangrenous]], first turning black, then greenish yellow. If the patient has survived, a line of demarcation between viable and [[necrotic]] tissue would become sharply defined from days 7 to 10. [[Sloughing]] of [[necrotic]] skin would reveal the underlying [[pus]] and extensive [[liquefactive necrosis]] of [[Subcutaneous tissue|subcutaneous tissues]], which will be significantly more extensive than would be suspected with the overlying area of [[necrotic]] skin. [[Metastatic]] [[abscesses]] and pulmonary distress may develop as well. Common complications of Fournier gangrene include:<ref name="pmid19669962">{{cite journal| author=Akcan A, Sözüer E, Akyildiz H, Yilmaz N, Küçük C, Ok E| title=Necessity of preventive colostomy for Fournier's gangrene of the anorectal region. | journal=Ulus Travma Acil Cerrahi Derg | year= 2009 | volume= 15 | issue= 4 | pages= 342-6 | pmid=19669962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19669962  }} </ref><ref name="pmid16891442">{{cite journal| author=Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I et al.| title=Fournier's gangrene and its emergency management. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 970 | pages= 516-9 | pmid=16891442 | doi=10.1136/pgmj.2005.042069 | pmc=2585703 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16891442  }} </ref> [[Renal failure]], [[acute respiratory distress syndrome]], [[heart failure]], [[cardiac arrhythmias]], septic metastasis, [[urinary tract infection]], [[stroke]], acute [[thromboembolic]] disease of lower extremities, wound infection, prolonged [[ileus]] (7 days), and eventration or evisceration. Depending on the underlying comorbidities, the prognosis of Fournier gangrene varies. Some of the prognostic factors include: Presence of severe [[sepsis]] and whether the affected area calculation/extension of the [[necrosis]] is ≥5% of the body surface area.
==Natural History, Complications, and Prognosis==
===Natural history===
If left untreated, the acute inflammatory changes spread quickly, accompanied by [[high fever]] and extreme weakness.<ref name="pmid20542593">{{cite journal| author=Morgan MS| title=Diagnosis and management of necrotising fasciitis: a multiparametric approach. | journal=J Hosp Infect | year= 2010 | volume= 75 | issue= 4 | pages= 249-57 | pmid=20542593 | doi=10.1016/j.jhin.2010.01.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20542593  }} </ref><ref name="pmid8436051">{{cite journal| author=Ecker KW, Derouet H, Omlor G, Mast GJ| title=[Fournier's gangrene]. | journal=Chirurg | year= 1993 | volume= 64 | issue= 1 | pages= 58-62 | pmid=8436051 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8436051  }}</ref> The overlying skin becomes smooth, tense and shiny and diffuse [[erythema]] without distinct borders are seen.
During the first 1 or 2 days, the lesions develop with progressive color changes from red to purple to blue and then become [[gangrene|gangrenous]], first turning black, then greenish yellow. If the patient has survived, a line of demarcation between viable and [[necrotic]] tissue would become sharply defined from days 7 to 10.
[[Sloughing]] of [[necrotic]] skin would reveal the underlying [[pus]] and extensive [[liquefactive necrosis]] of [[Subcutaneous tissue|subcutaneous tissues]], which will be significantly more extensive than would be suspected with the overlying area of [[necrotic]] skin. [[Metastatic]] [[abscesses]] and pulmonary distress may develop as well.
The most common foci of Fournier 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>
*[[Enemas|Steroid enemas]] for [[colitis|radiation proctitis]]<br>
*[[Hemorrhoidectomy]]<br>
*[[Anal fissure|Anal fissures excision]]<br>
*[[Diverticulitis]]<br>
*[[Colon|Colonic perforations]]<br>
*[[Ischiorectal fossa|Ischiorectal]], [[perirectal]], or [[perianal abscesses]]<br>
*[[Appendicitis]]<br>
*[[Enemas|Steroid enemas]] for [[Colitis|radiation proctitis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Trauma<br>
*[[Cancer]] invasion to external genitalia<br>
*[[Hemipelvectomy]]<br>
*[[Epididymitis]] or [[orchitis]]<br>
*[[Penile implant|Penile artificial implant]] or a foreign body<br>
*[[Hydrocele]] aspiration<br>
*Genital piercing<br>
*[[Cavernous sinus|Intracavernosal]] cocaine<br>
*[[Urethral catheterization]] or instrumentation<br>
*[[Penile prosthesis|Penile implants]] insertion<br>[[Biopsy|Prostatic biopsy]]<br>
*[[Vasectomy]]<br>
*Urethral strictures with urinary extravasation
| style="padding: 5px 5px; background: #F5F5F5;" |
*Blunt [[perineal]] trauma<br>
*[[Intramuscular injection|Intramuscular injections]]<br>
*Genital piercings<br>
*[[Furuncle|Scrotal furuncle]]<br>
*Perineal or pelvic surgery/inguinal [[herniorrhaphy]]<br>
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Episiotomy]] wound<br>
*Infected [[bartholin's gland]]<br>
*[[Abortion|Septic abortion]]<br>
*Genital mutilation<br>
*Coital injury
|}
'''Neonates and Children'''
*Trauma<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>
*Burns
*Insect bites
*Circumcision
===Complications===
Common complications of Fournier gangrene include:<ref name="pmid19669962">{{cite journal| author=Akcan A, Sözüer E, Akyildiz H, Yilmaz N, Küçük C, Ok E| title=Necessity of preventive colostomy for Fournier's gangrene of the anorectal region. | journal=Ulus Travma Acil Cerrahi Derg | year= 2009 | volume= 15 | issue= 4 | pages= 342-6 | pmid=19669962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19669962  }} </ref><ref name="pmid16891442">{{cite journal| author=Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I et al.| title=Fournier's gangrene and its emergency management. | journal=Postgrad Med J | year= 2006 | volume= 82 | issue= 970 | pages= 516-9 | pmid=16891442 | doi=10.1136/pgmj.2005.042069 | pmc=2585703 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16891442  }} </ref>
'''Systemic complications'''
*[[Renal failure]]
*[[Acute respiratory distress syndrome]]
*[[Heart failure]]
*[[Cardiac arrhythmias]]
*Septic metastasis
*[[Urinary tract infection]]
*[[Stroke]]
*Acute [[thromboembolic]] disease of lower extremities
'''Surgical complications'''
*Wound infection
*[[Stoma]]-related complications
*Prolonged [[ileus]] (7 days)
*Eventration or evisceration
'''Long term complications'''
*Pain (50% of patients)
*Impaired sexual function (due to penile deviation/torsion, loss of sensitivity of the penile skin or pain during erection)
*Stool [[incontinence]]
*Extensive [[Scar|scarring]]
===Prognosis===
Depending on the underlying comorbidities, the prognosis of Fournier gangrene varies. Some of the prognostic factors include:
*Severe [[sepsis]]
*If the affected area calculation/extension of the [[necrosis]] is:
*<3% of the body surface area, death is rare
*≥5% of the body surface area, the prognosis is worse


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 17:42, 7 September 2017

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Steven C. Campbell, M.D., Ph.D.; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[1]; Jesus Rosario Hernandez, M.D. [2]

Overview

If left untreated, the acute inflammatory changes spread quickly, accompanied by high fever and extreme weakness.[1][2] The overlying skin becomes smooth, tense and shiny and diffuse erythema without distinct borders are seen. During the first 1 or 2 days, the lesions develop with progressive color changes from red to purple to blue and then become gangrenous, first turning black, then greenish yellow. If the patient has survived, a line of demarcation between viable and necrotic tissue would become sharply defined from days 7 to 10. Sloughing of necrotic skin would reveal the underlying pus and extensive liquefactive necrosis of subcutaneous tissues, which will be significantly more extensive than would be suspected with the overlying area of necrotic skin. Metastatic abscesses and pulmonary distress may develop as well. Common complications of Fournier gangrene include:[3][4] Renal failure, acute respiratory distress syndrome, heart failure, cardiac arrhythmias, septic metastasis, urinary tract infection, stroke, acute thromboembolic disease of lower extremities, wound infection, prolonged ileus (7 days), and eventration or evisceration. Depending on the underlying comorbidities, the prognosis of Fournier gangrene varies. Some of the prognostic factors include: Presence of severe sepsis and whether the affected area calculation/extension of the necrosis is ≥5% of the body surface area.

Natural History, Complications, and Prognosis

Natural history

If left untreated, the acute inflammatory changes spread quickly, accompanied by high fever and extreme weakness.[1][2] The overlying skin becomes smooth, tense and shiny and diffuse erythema without distinct borders are seen.

During the first 1 or 2 days, the lesions develop with progressive color changes from red to purple to blue and then become gangrenous, first turning black, then greenish yellow. If the patient has survived, a line of demarcation between viable and necrotic tissue would become sharply defined from days 7 to 10.

Sloughing of necrotic skin would reveal the underlying pus and extensive liquefactive necrosis of subcutaneous tissues, which will be significantly more extensive than would be suspected with the overlying area of necrotic skin. Metastatic abscesses and pulmonary distress may develop as well.


The most common foci of Fournier gangrene include:[5][6]

Anorectal Genitourinary Dermatology Gynaecological

Neonates and Children

  • Trauma[6]
  • Burns
  • Insect bites
  • Circumcision

Complications

Common complications of Fournier gangrene include:[3][4]

Systemic complications

Surgical complications

  • Wound infection
  • Stoma-related complications
  • Prolonged ileus (7 days)
  • Eventration or evisceration

Long term complications

  • Pain (50% of patients)
  • Impaired sexual function (due to penile deviation/torsion, loss of sensitivity of the penile skin or pain during erection)
  • Stool incontinence
  • Extensive scarring

Prognosis

Depending on the underlying comorbidities, the prognosis of Fournier gangrene varies. Some of the prognostic factors include:

  • Severe sepsis
  • If the affected area calculation/extension of the necrosis is:
  • <3% of the body surface area, death is rare
  • ≥5% of the body surface area, the prognosis is worse

References

  1. ↑ 1.0 1.1 Morgan MS (2010). "Diagnosis and management of necrotising fasciitis: a multiparametric approach". J Hosp Infect. 75 (4): 249–57. doi:10.1016/j.jhin.2010.01.028. PMID 20542593.
  2. ↑ 2.0 2.1 Ecker KW, Derouet H, Omlor G, Mast GJ (1993). "[Fournier's gangrene]". Chirurg. 64 (1): 58–62. PMID 8436051.
  3. ↑ 3.0 3.1 Akcan A, Sözüer E, Akyildiz H, Yilmaz N, Küçük C, Ok E (2009). "Necessity of preventive colostomy for Fournier's gangrene of the anorectal region". Ulus Travma Acil Cerrahi Derg. 15 (4): 342–6. PMID 19669962.
  4. ↑ 4.0 4.1 Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I; et al. (2006). "Fournier's gangrene and its emergency management". Postgrad Med J. 82 (970): 516–9. doi:10.1136/pgmj.2005.042069. PMC 2585703. PMID 16891442.
  5. ↑ Eke N (2000). "Fournier's gangrene: a review of 1726 cases". Br J Surg. 87 (6): 718–28. doi:10.1046/j.1365-2168.2000.01497.x. PMID 10848848.
  6. ↑ 6.0 6.1 Amendola MA, Casillas J, Joseph R, Antun R, Galindez O (1994). "Fournier's gangrene: CT findings". Abdom Imaging. 19 (5): 471–4. PMID 7950832.
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