Skip to main content

Advertisement

Log in

Fournier’s gangrene

  • Report of Five Cases and Review
  • Published:
Hellenic Journal of Surgery

Abstract

Fournier’s gangrene (FG) is a rare but life threatening disease. Although originally thought to be an idiopathic process, FG has been shown to have a predilection for patients with diabetes as well as long term alcohol misuse; however, it can also affect patients with non-obvious immune compromise. The nidus is usually located in the genitourinary tract, lower gastrointestinal tract, or skin. FG is a mixed infection caused by both aerobic and anaerobic bacterial flora. The development and progression of the gangrene is often fulminating and can rapidly cause multiple organ failure and death. Because of potential complications, it is important to diagnose the disease process as early as possible. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the death rate remains high.

In the current study, we present five cases of FG treated in our department during 2007–2009, followed by a brief review of the literature.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smith, G.L., C.B. Bunker, and M.D. Dinneen, Fournier’s gangrene. Br J Urol, 1998. 81(3): p. 347–355.

    CAS  PubMed  Google Scholar 

  2. Fournier, J.-A., Gangrene foudroyante de la verge. Semaine Medicale 1883. 3: p. 345–348.

    Google Scholar 

  3. Nathan, B., Fournier’s gangrene: a historical vignette. Can J Surg, 1998. 41(1): p. 72.

    CAS  PubMed  Google Scholar 

  4. Jones, R.B., et al., Fournier’s syndrome: necrotizing subcutaneous infection of the male genitalia. J Urol, 1979. 122(3): p. 279–282.

    CAS  PubMed  Google Scholar 

  5. Gray, J.A., Gangrene of the genitalia as seen in advanced periurethral extravasation with phlegmon. J Urol, 1960. 84: p. 740–745.

    CAS  PubMed  Google Scholar 

  6. Meleney, F., Hemolytic streptococcus gangrene. Arch Surg., 1924. 9: p. 317–364.

    Google Scholar 

  7. Pawlowski, W., M. Wronski, and I.W. Krasnodebski, [Fournier’s gangrene]. Pol Merkur Lekarski, 2004. 17(97): p. 85–87.

    PubMed  Google Scholar 

  8. Safioleas, M., et al., Fournier’s gangrene: exists and it is still lethal. Int Urol Nephrol, 2006. 38(3–4): p. 653–657.

    CAS  PubMed  Google Scholar 

  9. Ash, L. and J. Hale, CT findings of perforated rectal carcinoma presenting as Fournier’s gangrene in the emergency department. Emerg Radiol, 2005. 11(5): p. 295–297.

    Article  PubMed  Google Scholar 

  10. Amendola, M.A., et al., Fournier’s gangrene: CT findings. Abdom Imaging, 1994. 19(5): p. 471–474.

    Article  CAS  PubMed  Google Scholar 

  11. Atakan, I.H., et al., A life-threatening infection: Fournier’s gangrene. Int Urol Nephrol, 2002. 34(3): p. 387–392.

    Article  CAS  PubMed  Google Scholar 

  12. Campbell, J.C., Fournier’s gangrene. Br J Urol, 1955. 27(2): p. 106–115.

    Article  CAS  PubMed  Google Scholar 

  13. Kilby, J.O., Gangrene of scrotum and penis. Br J Surg, 1962. 49: p. 619–620.

    Article  CAS  PubMed  Google Scholar 

  14. Bahlmann, J.C., I.J. Fourie, and T.C. Arndt, Fournier’s gangrene: necrotising fasciitis of the male genitalia. Br J Urol, 1983. 55(1): p. 85–88.

    Article  CAS  PubMed  Google Scholar 

  15. Smulewicz, J.J. and D. Donner, Gas gangrene of the scrotum. J Urol, 1974. 111(5): p. 621–625.

    CAS  PubMed  Google Scholar 

  16. Thadepalli, H., et al., Polymicrobial genital gangrene (Fournier’s gangrene): clinical, microbiologic, and therapeutic features. J Natl Med Assoc, 1982. 74(3): p. 273–277.

    CAS  PubMed  Google Scholar 

  17. Bour, J. and G. Steinhardt, Penile necrosis in patients with diabetes mellitus and end stage renal disease. J Urol, 1984. 132(3): p. 560–562.

    CAS  PubMed  Google Scholar 

  18. Frydenberg, M., Penile gangrene: a separate entity from Fournier’s syndrome? Br J Urol, 1988. 61(6): p. 532–533.

    Article  CAS  PubMed  Google Scholar 

  19. Weiner, D.M. and F.C. Lowe, Surgical management of ischemic penile gangrene in diabetics with end stage atherosclerosis. J Urol, 1996. 155(3): p. 926–929.

    Article  CAS  PubMed  Google Scholar 

  20. Jeong, H.J., et al., Prognostic factors in Fournier gangrene. Int J Urol, 2005. 12(12): p. 1041–1044.

    Article  PubMed  Google Scholar 

  21. Rotondo, N., Fournier’s gangrene: an unusual presentation of sepsis. J Emerg Med, 2002. 23(4): p. 413–414.

    Article  PubMed  Google Scholar 

  22. Tahmaz, L., et al., Fournier’s gangrene: report of thirty-three cases and a review of the literature. Int J Urol, 2006. 13(7): p. 960–967.

    Article  PubMed  Google Scholar 

  23. Eke, N., Fournier’s gangrene: a review of 1726 cases. Br J Surg, 2000. 87(6): p. 718–728.

    Article  CAS  PubMed  Google Scholar 

  24. Grayson, D.E., et al., Emphysematous infections of the abdomen and pelvis: a pictorial review. Radiographics, 2002. 22(3): p. 543–561.

    PubMed  Google Scholar 

  25. Gurdal, M., et al., Predisposing factors and treatment outcome in Fournier’s gangrene. Analysis of 28 cases. Urol Int, 2003. 70(4): p. 286–290.

    Article  PubMed  Google Scholar 

  26. Levenson, R.B., A.K. Singh, and R.A. Novelline, Fournier gangrene: role of imaging. Radiographics, 2008. 28(2): p. 519–528.

    Article  PubMed  Google Scholar 

  27. Clayton, M.D., et al., Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet, 1990. 170(1): p. 49–55.

    CAS  PubMed  Google Scholar 

  28. Elem, B. and P. Ranjan, Impact of immunodeficiency virus (HIV) on Fournier’s gangrene: observations in Zambia. Ann R Coll Surg Engl, 1995. 77(4): p. 283–286.

    CAS  PubMed  Google Scholar 

  29. Yanar, H., et al., Fournier’s gangrene: risk factors and strategies for management. World J Surg, 2006. 30(9): p. 1750–1754.

    Article  PubMed  Google Scholar 

  30. Johnin, K., et al., Fournier’s gangrene caused by Candida species as the primary organism. Urology, 2000. 56(1): p. 153.

    Article  CAS  PubMed  Google Scholar 

  31. Yaghan, R.J., T.M. Al-Jaberi, and I. Bani-Hani, Fournier’s gangrene: changing face of the disease. Dis Colon Rectum, 2000. 43(9): p. 1300–1308.

    Article  CAS  PubMed  Google Scholar 

  32. Rotstein, O.D., T.L. Pruett, and R.L. Simmons, Mechanisms of microbial synergy in polymicrobial surgical infections. Rev Infect Dis, 1985. 7(2): p. 151–170.

    CAS  PubMed  Google Scholar 

  33. Rutchik S, S.M., Fungal Fournier gangrene. Infect Urol, 2003. 16: p. 54–56.

    Google Scholar 

  34. Tleyjeh, I.M., et al., Lactobacillus gasseri causing Fournier’s gangrene. Scand J Infect Dis, 2004. 36(6–7): p. 501–503.

    Article  PubMed  Google Scholar 

  35. Laor, E., et al., Outcome prediction in patients with Fournier’s gangrene. J Urol, 1995. 154(1): p. 89–92.

    Article  CAS  PubMed  Google Scholar 

  36. Paty, R. and A.D. Smith, Gangrene and Fournier’s gangrene. Urol Clin North Am, 1992. 19(1): p. 149–162.

    CAS  PubMed  Google Scholar 

  37. Laucks, S.S., 2nd, Fournier’s gangrene. Surg Clin North Am, 1994. 74(6): p. 1339–1352.

    PubMed  Google Scholar 

  38. Sutherland, M.E. and A.A. Meyer, Necrotizing soft-tissue infections. Surg Clin North Am, 1994. 74(3): p. 591–607.

    CAS  PubMed  Google Scholar 

  39. Saijo, S., et al., Extremely extended Fournier’s gangrene. Dermatologica, 1990. 181(3): p. 228–232.

    Article  CAS  PubMed  Google Scholar 

  40. Chawla, S.N., C. Gallop, and J.H. Mydlo, Fournier’s gangrene: an analysis of repeated surgical debridement. Eur Urol, 2003. 43(5): p. 572–575.

    Article  PubMed  Google Scholar 

  41. Benizri, E., et al., Gangrene of the perineum. Urology, 1996. 47(6): p. 935–939.

    Article  CAS  PubMed  Google Scholar 

  42. Eke, N., Onwuchekwa, AC., Fournier’s gangrene of the penis associated with adenocarcinoma of the rectum and diabetes mellitus. Acta Urol Ital, 1999. 13: p. 207–209.

    Google Scholar 

  43. Wolach, M.D., et al., Treatment and complications of Fournier’s gangrene. Br J Urol, 1989. 64(3): p. 310–314.

    Article  CAS  PubMed  Google Scholar 

  44. Walker, L., et al., Fournier’s gangrene and urethral problems. Br J Urol, 1984. 56(5): p. 509–511.

    CAS  PubMed  Google Scholar 

  45. Elliott, D., J.A. Kufera, and R.A. Myers, The microbiology of necrotizing soft tissue infections. Am J Surg, 2000. 179(5): p. 361–366.

    Article  CAS  PubMed  Google Scholar 

  46. Morykwas, M.J., et al., Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg, 1997. 38(6): p. 553–562.

    Article  CAS  PubMed  Google Scholar 

  47. Weinfeld, A.B., et al., Circumferential negative-pressure dressing (VAC) to bolster skin grafts in the reconstruction of the penile shaft and scrotum. Ann Plast Surg, 2005. 54(2): p. 178–183.

    Article  CAS  PubMed  Google Scholar 

  48. Hejase, M.J., et al., Genital Fournier’s gangrene: experience with 38 patients. Urology, 1996. 47(5): p. 734–739.

    Article  CAS  PubMed  Google Scholar 

  49. Capelli-Schellpfeffer, M. and G.S. Gerber, The use of hyperbaric oxygen in urology. J Urol, 1999. 162(3 Pt 1): p. 647–654.

    Article  CAS  PubMed  Google Scholar 

  50. Stephens, B.J., et al., Fournier’s gangrene: historic (1764–1978) versus contemporary (1979–1988) differences in etiology and clinical importance. Am Surg, 1993. 59(3): p. 149–154.

    CAS  PubMed  Google Scholar 

  51. Morpurgo, E. and S. Galandiuk, Fournier’s gangrene. Surg Clin North Am, 2002. 82(6): p. 1213–1224.

    Article  PubMed  Google Scholar 

  52. Martinelli, G., et al., Fournier’s gangrene: a clinical presentation of necrotizing fasciitis after bone marrow transplantation. Bone Marrow Transplant, 1998. 22(10): p. 1023–1026.

    Article  CAS  PubMed  Google Scholar 

  53. Nisbet, A.A. and I.M. Thompson, Impact of diabetes mellitus on the presentation and outcomes of Fournier’s gangrene. Urology, 2002. 60(5): p. 775–779.

    Article  PubMed  Google Scholar 

  54. Theiss, M., et al., [Cosmetic and functional long-term outcome after operation of Fournier gangrene]. Urologe A, 1996. 35(4): p. 338–341.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G. Rallis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rallis, G., Skouteris, D., Giouzelis, D. et al. Fournier’s gangrene. Hellenic J Surg 82, 381–387 (2010). https://doi.org/10.1007/s13126-010-0059-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13126-010-0059-x

Keywords

Navigation