0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

FOURNIER GANGRENE

Fournier gangrene is a rapidly progressing, necrotizing infection of the scrotum,

penis, or perineum, sparing the testicles. It usually occurs secondary to direct

spread from infections in the perirectal area, urogenital tract, or skin of the geni-

talia. Predominant organisms are Bacteroides fragilisandE. coli, but may also

include streptococci, staphylococci,and Clostridia (rarely fungal or anaerobic).

These infections occur most commonly in patients with diabetes, immunosup-

pression, obesity, malignancy, chronic steroid use, or chronic alcoholism.

SYMPTOMS

■ Scrotal pain or itching are early symptoms.

■ Fever, malaise, and intense perineal swelling develop.

EXAM

■ Patients are often toxic appearing, with marked tachycardia.

■ Hypotension is common.

■ Involved skin is tender to palpation and may have crepitus, erythema,

edema, or frank necrosis (see Figure 18.5).

DIAGNOSIS

■ With strong clinical suspicion, imaging only delays treatment.

■ If the diagnosis is equivocal, CT or MRI scanning can be used to demon-

strate fluid collections in deep fascial planes or gas within the tissue.

TREATMENT

■ Aggressive supportive care

■ Broad spectrum antibiotics: Imipenem-cilastin + vancomycin

■ Emergent surgical debridement

FIGURE 18.5. Fournier gangrene.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency

Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:615.)

Definitive therapy for Fournier

gangrene is wide surgical

debridement.