Fournier gangrene: Difference between revisions

	Fournier gangrene;
ICD-10	N49.8 (ILDS N49.81), N76.8
ICD-9	608.83
DiseasesDB	31119
MeSH	D018934

	WikiDoc Resources for Fournier gangrene
Articles
Most recent articles on Fournier gangrene Most cited articles on Fournier gangrene Review articles on Fournier gangrene Articles on Fournier gangrene in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Fournier gangrene Images of Fournier gangrene Photos of Fournier gangrene Podcasts & MP3s on Fournier gangrene Videos on Fournier gangrene
Evidence Based Medicine
Cochrane Collaboration on Fournier gangrene Bandolier on Fournier gangrene TRIP on Fournier gangrene
Clinical Trials
Ongoing Trials on Fournier gangrene at Clinical Trials.gov Trial results on Fournier gangrene Clinical Trials on Fournier gangrene at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Fournier gangrene NICE Guidance on Fournier gangrene NHS PRODIGY Guidance FDA on Fournier gangrene CDC on Fournier gangrene
Books
Books on Fournier gangrene
News
Fournier gangrene in the news Be alerted to news on Fournier gangrene News trends on Fournier gangrene
Commentary
Blogs on Fournier gangrene
Definitions
Definitions of Fournier gangrene
Patient Resources / Community
Patient resources on Fournier gangrene Discussion groups on Fournier gangrene Patient Handouts on Fournier gangrene Directions to Hospitals Treating Fournier gangrene Risk calculators and risk factors for Fournier gangrene
Healthcare Provider Resources
Symptoms of Fournier gangrene Causes & Risk Factors for Fournier gangrene Diagnostic studies for Fournier gangrene Treatment of Fournier gangrene
Continuing Medical Education (CME)
CME Programs on Fournier gangrene
International
Fournier gangrene en Espanol Fournier gangrene en Francais
Business
Fournier gangrene in the Marketplace Patents on Fournier gangrene
Experimental / Informatics
List of terms related to Fournier gangrene

← Older edit Newer edit →

VisualWikitext

Revision as of 22:41, 10 October 2016

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]

Synonyms and keywords: Idiopathic gangrene of scrotum; Periurethral phlegmon; Streptococcal scrotal gangrene

Template:Search infobox

Overview

Fournier gangrene is a type of necrotizing infection (gangrene) of the perineal, genital or perianal regions usually affecting the male genitals but can also occur in female and children.^[1] It is a fulminant form of necrotizing fasciitis. It was first described by Baurienne in 1764 and is named after a French venereologist, Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883.^[2]^[3]

Historical Perspective

Fournier's gangrene was first described by in 1764 by Baurienne.^[2]
The detailed description of fournier's gangrene was given by Jean Alfred Fournier, who is a French venereologist in 1883.^[3]

Classification

Pathophysiology

Causes

Aetiology

In the majority of cases Fournier gangrene is a mixed infection caused by both aerobic and anaerobic bacteria.^[4]

Differentiating Fournier gangrene from Other Diseases

Epidemiology and Demographics

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.^[5] 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.^[6]

In Turkey it was reported that 46% of patients had diabetes mellitus^[7] whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).^[8]

Risk Factors

Common risk factors in the development of fournier's gangrene are:^[9]^[10]^[11]

Comorbid systemic disorders

Age>50 yrs
Male Gende
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:^[12]^[13]


Anorectal	Genitourinary	Dermatology	Gynaecological
Trauma Steroid enemas for radiation proctitis Hemorrhoidectomy Anal fissures excision Diverticulitis Colonic perforations Ischiorectal, perirectal, or perianal abscesses Appendicitis Steroid enemas for radiation proctitis	Trauma Cancer invasion to external genitalia Hemipelvectomy Epididymitis or orchitis Penile artificial implant or a foreign body Hydrocele aspiration Genital piercing Intracavernosal cocaine Urethral catheterization or instrumentation Penile implantsinsertion Prostatic biopsy Vasectomy Urethral strictures with urinary extravasation	Blunt perineal trauma Intramuscular injections Genital piercings Scrotal furuncle Perineal or pelvic surgery/inguinal herniography	Episiotomy wound Infected bartholins gland Septic abortion Genital mutilation Coital injury

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical examination

Gallery

Genitourinary system

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

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.^[7]

Antimicrobial Therapy

Fournier gangrene^[14]

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

Template:WhoNamedIt2 and Template:WhoNamedIt

References

↑ Smith GL, Bunker CB, Dinneen MD (1998). "Fournier's gangrene". Br J Urol. 81 (3): 347–55. PMID 9523650.
↑ ^2.0 ^2.1 Nathan B (1998). "Fournier's gangrene: a historical vignette". Can J Surg. 41 (1): 72. PMC 3950066. PMID 9492752.
↑ ^3.0 ^3.1 Chennamsetty A, Khourdaji I, Burks F, Killinger KA (2015). "Contemporary diagnosis and management of Fournier's gangrene". Ther Adv Urol. 7 (4): 203–15. doi:10.1177/1756287215584740. PMC 4580094. PMID 26445600.
↑ Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K (2006). "Fournier's gangrene and its emergency management". Postgrad Med J. 82 (970): 516–9. PMID 16891442.
↑ Vaz I (2006). "Fournier gangrene". Trop Doct. 36 (4): 203–4. PMID 17034687.
↑ Herzog W (1987). "[Fournier gangrene--also in females?]". Zentralbl Chir. 112 (9): 564–76. PMID 2956804.
↑ ^7.0 ^7.1 Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I (2006). "Fournier's gangrene: risk factors and strategies for management". World J Surg. 30 (9): 1750–4. PMID 16927060.
↑ Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O (2006). "Fournier's gangrene: report of thirty-three cases and a review of the literature". Int J Urol. 13 (7): 960–7. PMID 16882063.
↑ Clayton MD, Fowler JE, Sharifi R, Pearl RK (1990). "Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia". Surg Gynecol Obstet. 170 (1): 49–55. PMID 2294630.
↑ Morpurgo E, Galandiuk S (2002). "Fournier's gangrene". Surg Clin North Am. 82 (6): 1213–24. PMID 12516849.
↑ Vick R, Carson CC (1999). "Fournier's disease". Urol Clin North Am. 26 (4): 841–9. PMID 10584624.
↑ 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.
↑ Amendola MA, Casillas J, Joseph R, Antun R, Galindez O (1994). "Fournier's gangrene: CT findings". Abdom Imaging. 19 (5): 471–4. PMID 7950832.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

Template:WH Template:WS

[pmid9523650-1] Smith GL, Bunker CB, Dinneen MD (1998). "Fournier's gangrene". Br J Urol. 81 (3): 347–55. PMID 9523650.

[pmid9492752-2] 2.0 ^2.1 Nathan B (1998). "Fournier's gangrene: a historical vignette". Can J Surg. 41 (1): 72. PMC 3950066. PMID 9492752.

[pmid26445600-3] 3.0 ^3.1 Chennamsetty A, Khourdaji I, Burks F, Killinger KA (2015). "Contemporary diagnosis and management of Fournier's gangrene". Ther Adv Urol. 7 (4): 203–15. doi:10.1177/1756287215584740. PMC 4580094. PMID 26445600.

[4] Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K (2006). "Fournier's gangrene and its emergency management". Postgrad Med J. 82 (970): 516–9. PMID 16891442.

[5] Vaz I (2006). "Fournier gangrene". Trop Doct. 36 (4): 203–4. PMID 17034687.

[6] Herzog W (1987). "[Fournier gangrene--also in females?]". Zentralbl Chir. 112 (9): 564–76. PMID 2956804.

[Yanar2006-7] 7.0 ^7.1 Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I (2006). "Fournier's gangrene: risk factors and strategies for management". World J Surg. 30 (9): 1750–4. PMID 16927060.

[8] Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O (2006). "Fournier's gangrene: report of thirty-three cases and a review of the literature". Int J Urol. 13 (7): 960–7. PMID 16882063.

[pmid2294630-9] Clayton MD, Fowler JE, Sharifi R, Pearl RK (1990). "Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia". Surg Gynecol Obstet. 170 (1): 49–55. PMID 2294630.

[pmid12516849-10] Morpurgo E, Galandiuk S (2002). "Fournier's gangrene". Surg Clin North Am. 82 (6): 1213–24. PMID 12516849.

[pmid10584624-11] Vick R, Carson CC (1999). "Fournier's disease". Urol Clin North Am. 26 (4): 841–9. PMID 10584624.

[pmid10848848-12] 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.

[pmid7950832-13] Amendola MA, Casillas J, Joseph R, Antun R, Galindez O (1994). "Fournier's gangrene: CT findings". Abdom Imaging. 19 (5): 471–4. PMID 7950832.

[14] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

@@ Line 46: / Line 46: @@
 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 Gende
 :*Diabetes mellitus
 :*Alcohol misuse

Fournier gangrene
ICD-10	N49.8 (ILDS N49.81), N76.8
ICD-9	608.83
DiseasesDB	31119
MeSH	D018934