Morning Report: Fournier's Gangrene

Here’s Dr. Abram with today’s Morning Report!

Fournier’s Gangrene

Named for: Jean-Alfred Fournier, venereologist in Paris, in an 1883 lecture

Anatomy: Tends to run in between fascial planes, often sparing superficial and deep structures. Scarpa’s fascia can run up abdomen to clavicles.

Risk: Portal of entry, virulence of pathogen, immunocompromised, co-morbidities like diabetes, alcoholics. Typically 60-70 yo M with comorbidities. 10:1 M:F.

Between 15 and 54% mortality.

Common pathogens: Strep, Staph, Enterococcus, Anaerobes, Pseudomonas, Proteus, Klebsiella, Clostridium

Fournier’s Gangrene Severity Index: then the Updated FGSI – vitals and electrolytes

History and physical: Intense pain and ttp in genitals, can see edema or pruritis, fever/lethargy prodrome 2-7 days, dusky appearance to skin, crepitus (up to 65%), frank purulent drainage, feculent odor, sepsis

Tests: Labs, CT scan – will see soft tissue stranding, fascial thickening, may NOT have subcutaneous emphysema. If U/S – thickened scrotal wall and echogenic gas foci in scrotum considered pathognomonic “dirty shadowing”

Treatment: Surgical Emergency. ABC IOM. Can be tailored to patient co-morbidities, antibiotics, surgery. Vanc/zosyn, Cipro/clinda. Give tetanus. Hyperbaric oxygen (maybe).