Fournier gangrene

Background

• Polymicrobial necrotizing fasciitis of perineal, genital, or perianal anatomy
  • Microthrombosis of small subcutaneous vessels leads to gangrene of overlying skin
• Risk factors = DM, alcohol abuse

Clinical Features

• Benign infection or simple abscess that rapidly becomes virulent
• Marked pain, swelling, crepitus, ecchymosis

Treatment

• Abx
  • Must cover gram positive, gram negative, and anaerobes
    • (Imipenem 1gm IV q24hr OR meropenem 500mg-1gm IV q8hr) + vancomycin
• Surgical debridement

Disposition

• Urologic consultation, in addition to surgery consultation, is required if:
  • Periurethral abscess is inciting event
  • Infection has secondarily invaded the urinary tract and a suprapubic catheter is needed

See Also

Necrotizing Fasciitis

Source

Tintinalli