Fournier's gangrene
The content of the article:
- Causes and risk factors
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Fournier's gangrene (subfascial phlegmon of the genital organs, gangrenous erysipelas, Fournier's disease, Fournier's syndrome, necrotizing fasciitis) is an acute necrosis of the tissues of the external genital organs caused by the spread of anaerobic infection from the pararectal region or urinary tract. In men, the penis and scrotum are drawn into the pathological process, in women, the labia minora, clitoris, perineum, pubis and thighs.
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Fournier's gangrene mainly affects men 50–70 years old, suffering from diabetes mellitus or some other serious chronic disease. In women, this pathology is extremely rare (no more than 1% of all cases of the disease).
Causes and risk factors
The development of Fournier's gangrene is caused by a simultaneous combination of several factors:
- infection with an association of aerobic and anaerobic microorganisms;
- decrease in general and local immunity;
- violation of the blood supply to tissues caused by thrombosis of the blood vessels;
- pronounced tissue edema;
- a high degree of allergization of the body.
Risk factors are:
- diabetes;
- anal fissures;
- perianal and perirectal abscesses;
- diverticulitis;
- colorectal cancer;
- urethral injury;
- orchitis;
- epididymitis;
- urinary tract infections;
- poor hygiene of the perineum;
- trauma to the scrotum and penis;
- foreign body of the rectum;
- therapeutic microclysters with corticosteroids;
- installation of a penile implant;
- injecting cocaine into the penis;
- genital piercing;
- alcoholism.
Symptoms
The prodromal period with Fournier's gangrene is 2 to 9 days. First, symptoms of general intoxication appear:
- increased body temperature;
- chills;
- headaches and muscle pains;
- decreased appetite.
The prodormal period of Fournier's gangrene is characterized by general signs of intoxication of the body
The scrotum turns red and swells, there is intense pain in the perineum.
The swelling of the scrotum increases rapidly. On palpation, you can hear the sound characteristic of gangrene - crepitus. Tissue ischemia leads to the appearance of black-purple foci on the skin, rapidly increasing and merging with each other. In the future, necrotic tissue is rejected.
If the patient does not receive urgent medical attention, then the gangrenous process will spread to the hips, penis, and lower parts of the anterior abdominal wall.
Diagnostics
Diagnosis of Fournier's gangrene in the later stages is usually straightforward. In the early days of the development of the pathological process, diagnostic difficulties may arise, requiring differential diagnosis with soft chancre, syphilis, gangrenous forms of inguinal lymphogranulomatosis.
Treatment
Patients with Fournier's gangrene are subject to urgent hospitalization in the intensive care unit of a surgical hospital. Antibiotic therapy with broad-spectrum antibiotics (carbapenems, ciprofloxacin, clindamycin, IV generation cephalosporins) in combination with trichopolum is prescribed. The patient is simultaneously prepared for surgery: detoxification therapy, correction of existing violations of water and electrolyte balance, prevention of thromboembolic complications are performed.
Fournier's gangrene needs urgent treatment and surgery
Surgical intervention for Fournier's gangrene consists in removing dead tissue and performing wide stripe incisions. With this pathology, there is always a high probability of repeated surgical interventions.
Methods of extracorporeal detoxification (plasmapheresis, hemosorption, ultraviolet blood irradiation) and hyperbaric oxygenation (HBO) are of great importance in the therapy of Fournier's gangrene.
After cleaning the wound and improving the general condition, reconstructive operations are performed (stalk, muscle plastics, split autodermoplasty, skin plastics with local tissues).
Possible complications and consequences
Patients who have had Fournier's gangrene subsequently suffer from pain and pronounced edema in the external genital area, which is due to the formation of rough scar tissue.
Forecast
Mortality in Fournier's gangrene is high even with timely treatment and ranges from 10 to 45% (according to various sources).
Prevention
Prevention of Fournier's gangrene includes the following measures:
- thorough hygiene of the genitals;
- timely detection and treatment of urological and proctological diseases;
- correction of blood glucose levels in patients with diabetes mellitus.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
