Fournier gangrene

A fulminant form of necrotising fasciitis of the perineal, genital or perianal regions

• See separate topic on necrotising infections

Pathophysiology

• Typically Klebsiella, streptococci, staphylococci, clostridia, Bacteroides, and corynebacterium
• Urogenital infections tend to extend posteriorly along Bucks and Dartos fascia up to the Colles fascia, but are limited from the anal margin by the attachment of the Colles fascia to the perineal body
• Anorectal infections usually involve the perianal skin
• Testes are usually spared due intra-abdominal blood supply

Presentation

• Starts as an area of cellulitis at the initial focus of infection in the perineum or perianal region - intense pain and swelling
• Crepitus is common
• Necrotic patches later appear over the overlying skin and progress to more extensive necrosis
• Severe systemic illness which may be disproportionate to local signs
• Usually rapidly progressive. Necrotising fasciitis can extend to penis and scrotum and up the anterior abdominal wall

Management

• As per necrotising infections topic