Fournier’s Gangrene – Symptoms, Causes And Treatment

What is Fournier’s Gangrene?

Fournier’s gangrene is a fast progressing, tissue-destroying infection on the genitals and nearby region. It is a medical emergency that can be fatal without immediate treatment.

The infection-causing organisms can enter the genitalia, perineum, or colorectal area through a wound. The skin, superficial and deep fibrous membranes are destroyed. The spread of infection takes place faster when the individual has an immune system deficiency. It reaches the abdominal wall, back, pelvis, retroperitoneum heartbeat even beyond.

What are the symptoms?

The symptoms of an advanced infection of the Fournier’s gangrene are:

• Greying or blackening of the skin
• Foul odor from the infection site
• Rapid heartbeat
• High fever
• Swelling in the affected area

Though Fournier’s gangrene is rare, it is required to treat the infection immediately to avoid fatality, multiple organ failure and amputation.

What are the causes of Fournier’s gangrene

Fournier’s gangrene is caused by a combination of aerobic and anaerobic bacteria. The bacteria damage the blood vessels and produce toxins as well as enzymes that destroy the tissue.

The infection spreads along with the connecting tissue between your skin and underlying muscles. It normally doesn’t harm the muscles. It spreads along the skin and muscle tissue but does not harm the muscles. 

An infection can begin when the skin breaks, such as through an injury or surgery, allowing bacteria to enter the body. The infection usually begins in the perineum, the area between the genitals and rectum, and spreads outward beneath the skin. It can also extend to your abdominal wall or buttocks.

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What are the possible risk factors of Fournier’s gangrene?

Fournier’s gangrene in men:

Men are 10 times more prone to Fournier’s gangrene than women. The testicles, urethra and the chamber inside the penis are filled with blood to produce an erection. The risk factors associated with men in this condition are:

• Prostate biopsy
• Penile prosthesis
• Vasectomy
• Zipper injury
• Hydrocele aspiration
• Circumcision

Women:

Though Fournier’s gangrene affects only a small percentage of women, it can affect the fibrous tissue that makes up the vaginal wall, abdominal wall, back, pelvis, and retroperitoneum.

The following are the risk factors associated with Fournier’s gangrene in women:

• Bacterial infection producing pus in the vaginal area
• Episiotomy 
• Septic abortion
• Hysterectomy
• Infected Bartholin’s gland

Other conditions that involve both men and women are:

• Perineal abscess
• Perineal trauma
• Injury during sexual intercourse
• Genital mutilation and piercing
• Catheterization injury

Children

Though Fournier’s gangrene is rate in children, the factors that influence them are:

• Circumcision
• Inguinal hernia
• Insect bites
• Infection

Complications for Fournier’s gangrene 

Several conditions that weakens the immune defenses of out body can leave an indivisual more vulnerable to Fournier’s gangrene. They include:

• Treatment with immune-suppressing medications
• Crohn’s disease 
• Lupus
• Leukemia
• Chemotherapy
• HIV infection
• Liver disease 
• Long-term treatment with corticosteroid medicines
• Malnutrition
• Advanced age
• Severe or morbid obesity

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How is Fournier’s gangrene diagnosed?

Fournier’s gangrene is detected through clinical examination itself. This type of examination includes palpation of the urogenital and perineal area, soft-tissue decay and other visible wounds. 

Diagnostic tests include the following:

• Imaging tests such as radiography, CT scan, ultrasound and MRI are done to get images of the internal organs. This helps in determining the presence and extent of the disease.
• Electrolyte and glucose levels 
• ABG (arterial blood gas) is a test that determines the pH of the blood. 
• Blood tests are used to check for indicators of infection and inflammation
• A tissue sample is usually obtained and examined under a microscope to determine the type of bacterial infection.

How is Fournier’s gangrene treated?

The early treatment for Fournier’s gangrene helps to prevent amputation, organ failure and removal of dying tissue and skin. The following are the treatment options for Fournier’s gangrene:

Medication – Antibiotics are provided to treat Fournier’s gangrene since a bacterial infection most typically causes it. A variety of antibiotics can be used against microorganisms. Other medications like antifungals may be used if testing of the afflicted tissue reveals the presence of fungus.

Surgical treatment – The dead tissues can be surgically removed based on the diagnosis. The skin is cut open during the surgery, and all the affected tissues are exposed. The surgeon removes the dead tissue and the other tissues that appears to be infected. The blood vessels are closed using a procedure called electrocautery so as to reduce the loss of blood during surgery. If the testicles are affected by gangrene, they may not be saved and removed by orchiectomy procedure.

The tissue samples are sent to the laboratory and tested for any type of bacteria and the extent of the damage. The surgeon rebuilds the surgical area after infection disappears and healthy tissue grows. This includes covering the surgical area by transplanting skin from a healthy area by a procedure called a skin graft.

Hyperbaric Oxygen Therapy – Hyperbaric oxygen therapy may be utilized with surgery and antibiotic therapy, particularly if other therapies have failed. Patients are placed in a pressurized room filled with pure oxygen during this therapy. This allows the lungs to take in more oxygen than they would if they were breathing at normal air pressure. The increased oxygen in the circulation causes stem cells and growth factors, which aid in the healing process.

How can one recover from Fournier’s gangrene?

To cover the places where dead tissue was removed, it is most likely that one would need reconstructive plastic surgery and skin grafts. Fournier’s gangrene causes permanent pain in around half of those who survive it. Following this disorder, men may experience painful erections or other forms of sexual issues.