Fournier gangrene

(Redirected from Fournier's gangrene)


Scrotal anatomy
Scrotal anatomy
  • Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.
    • Mostly bacteria lower GI system - B. fragilis and E. coli
    • Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin[1]
  • Mortality - often cited as 20-40%, but up to 80% in some studies[2]

Risk Factors

Clinical Features

Early Fournier's Gangrene with classic spotted area of ecchymosis (right lower scrotum) and draining lesion (mid scrotum). Draining lesions are not always present initially and even small areas of ecchymosis should be considered highly concerning for Fournier's Gangrene.
Progression of Fournier's Gangrene to larger draining lesion.
Fournier's Gangrene
  • Initial event is usually local trauma or extension of a UTI or perianal infection[1]
    • Gangrene develops over 2-7 days
  • Marked pain, localized swelling, crepitus, ecchymosis to genital or perineal area.
  • Fever
  • Malodorous purulent drainage
  • In late or severe cases, patient may present in septic shock

Differential Diagnosis

Testicular Diagnoses



  • CBC - very elevated leukocytosis
  • CMP - hyponatremia
  • ESR
  • CRP
  • Lactate
  • Type and Screen
  • Wound Culture
  • Blood Cultures
  • CT Abdomen/pelvis (only if diagnosis unclear or if requested by surgery/urology)




  • Admit to ICU

See Also


  1. 1.0 1.1 1.2 1.3 Shyam DC, Rapsang AG. Fournier's gangrene. Surgeon. 2013 Aug;11(4):222-32. doi: 10.1016/j.surge.2013.02.001.
  2. 2.0 2.1 Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.
  3. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52. doi:10.1093/cid/ciu444