Lecture notes for medical students

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2. Learning Objectives

3. Learning Objectives
1. Introduction & History
2. Relevant Anatomy, Physiology
3. Aetiology
4. Pathophysiology
5. Pathology
6. Classification
7. Clinical Features
8. Investigations
9. Management
10. Controversies
11. Prevention
12. Guidelines
13. Take home messages

4. Introduction & History.

5. Introduction & History.
Fournier gangrene, is defined as a
polymicrobial necrotizing fasciitis of the
perineal, perianal, or genital areas

6. Etiology

7. Etiology
• Idiopathic
• Congenital
• Traumatic
• Infections /Infestation
• Autoimmune
• Neoplastic (Benign/Malignant)
• Degenerative

8. Etiology
• Impaired immunity (eg, from diabetes) is
important for increasing susceptibility to
Fournier gangrene
• Trauma to the genitalia

9. Etiology: Predisposing conditions
• Diabetes mellitus
• Morbid obesity
• Alcoholism
• Cirrhosis
• Extremes of age
• Vascular disease of the
pelvis
• Systemic lupus
erythematosus
• Crohn’s disease
• HIV infection
• Malnutrition
• Iatrogenic
immunosuppression
(eg, from long-term
corticosteroid therapy)

10. Pathophysiology:Pathogens

11. Pathophysiology:Pathogens
Polymicrobial infection with an average of 4 isolates per
case
• Escherichia coli
• Bacteroides
• Proteus
• Staphylococcus
• Enterococcus
• Streptococcus (aerobic and anaerobic)
• Pseudomonas
• Klebsiella
• ClostridiumCandida albicans

12. Pathophysiology
• Infection spreads along the anatomical fascial
planes, often sparing the deep muscular structures
and, to variable degrees, the overlying skin.

13. Anatomy

14. Anatomy
• Camper fascia
• Scarpa fascia
• Colles fascia while it is continuous with
• Dartos fascia of the penis and scrotum
• Branches of the external and internal
pudendal arteries supply the scrotal wall.
• Branches of the external pudendal arteries
travels within Camper fascia
• Superiorly, Scarpa and Camper fascia
coalesce and attach to the clavicles,

15. Clinical Features

16. Clinical Features
• Demography
• Symptoms
• Signs
• Prognosis
• Complications

17. Demography

18. Demography
• Relatively uncommon, but the exact
incidence of the disease is unknown.
• No seasonal variation occurs.
• All over the world.
• Typical case -elderly man in his sixth or
seventh decade of life with comorbid
diseases
• The male-to-female ratio is approximately
10:1.
• Homosexual men may be at higher risk,

19. Symptoms

20. Symptoms
• Intense pain and tenderness in the genitalia.
• Fever and lethargy

21. Signs

22. Signs
• Fever, tachycardia, hypotension
• No toxicity to florid septic shock
• A feculent odor may be present
• Skin normal, erythematous, edematous,
cyanotic, bronzed, indurated, blistered,
and/or frankly gangrenous.
• Crepitus may be present

23. •

24. Prognosis

25. Prognosis
• Not bad.

26. Complications

27. Complications
• May progress to torso and thighs.

28. Investigations

29. Investigations
• Laboratory Studies
– Routine
– Special
• Imaging Studies
• Tissue diagnosis
– Cytology
• FNAC
– Histlogy

30. Diagnostic Studies

31. Diagnostic Studies
Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Endoscopy
• Nuclear scan

32. Differential Diagnosis

33. Differential Diagnosis
• Acute Epididymitis
• Balanitis
• Cellulitis
• Necrotizing Soft-Tissue Infections
• Gas Gangrene
• Hydrocele
• Orchitis
• Testicular Torsion

34. Tissue Diagnosis
Histological features
• Necrosis of the superficial and deep fascial
planes
• Fibrinoid coagulation of the nutrient
arterioles
• Polymorphonuclear cell infiltration
• Microorganisms identified within the
involved tissues

35. Management

36. Management
• Aggressive resuscitation
• Early, broad-spectrum antibiotics
• Tetanus prophylaxis
• Management of underlying comorbid
conditions
• Sepsis syndrome, >intravenous
immunoglobulin (IVIG)
• Radical excisional debridement

37. Questions
• Full question
• Short Note
• Long case
• Short case
• MCQs

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