HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
Life-threatening, fulminant, necrotizing inflammation of the male/female genitals, perineum or perianal region. The clinical picture corresponds to a foudroyant necrotizing fasciitis and requires immediate urological, proctosurgical or gynecological (intensive care) surgical intervention.
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EtiopathogenesisThis section has been translated automatically.
Unclear, possible infection with streptococci ( Erysipelas gangraenosum genitalium, Erysipelas genitalium), fusiform bacteria, spirochetes etc. Possibly Sanarelli-Shwartzman phenomenon. Predisposing factors discussed are previous surgery or trauma (e.g. also after dental piercing: Ekelius L et al. 2004) and systemic diseases (e.g. diabetes mellitus).
In summer 2018 the FDA has included Fournier gangrene as a rare side effect in the technical information of SGLT2 inhibitors. A connection with therapeutically intended glucosuria is suspected.
ManifestationThis section has been translated automatically.
- Age: between the 30th and 80th LJ.
- Average age is given in larger studies as 59 years.
- Less frequent in adolescents, children and infants.
LocalizationThis section has been translated automatically.
Perianal 40%; genital region: 40%;
Clinical featuresThis section has been translated automatically.
HistologyThis section has been translated automatically.
Mostly a compact tumour penetrating the entire dermis with nests and strands of oval to polygonal, distended cells with eosinophil granulated cytoplasm. The cell nuclei are often pynotic. A characteristic feature of granular cell tumors is a distinctly acanthotic epidermis.
Immunohistochemistry: Tumor cells are positive for S100, neuron-specific enolase and myelin basic protein.
Differential diagnosisThis section has been translated automatically.
General therapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
- High-dose parenteral therapy with broad-spectrum antibiotics such as ampicillin (e.g. Binotal). Adults: 150-200 mg/kg bw/day, children > 1st year of life 100-400 mg/kg bw/day distributed on 4 ED, infants < 1st week of life 50-150 mg/kg bw/day distributed on 2-3 ED, infants > 1st week of life 100-300 mg/kg bw/day distributed on 3-4 ED.
- Alternative: benzylpenicillin (e.g. penicillin Grünenthal), adults: 6 times 4 million IU/day, children > 1 year of age: 50,000-250,000 IU/kg bw/day divided into 4-6 days, infants < 1 week of life: 50,000-250,000 IU/kg bw/day divided into 2 days, infants > 1 week of life 75,000-350,000 IU/kg bw/day divided into 4 days.
- Alternative: gentamicin (e.g. refobacin) Adults: 3-5 mg/kg bw/day divided into 1-3 doses, children > 1st year of life: 5-7 mg/kg bw/day divided into 3-4 doses, infants < 1st week of life: 5 mg/kg bw/day divided into 2 doses, infants > 1st week of life: 7.5 mg/kg bw/day divided into 3 doses combined.
- For penicillin resistance: 3rd generation cephalosporins, e.g. cefotaxime (claforan) 3 times/day 2 g i.v.
- In case of resistance to therapy: combination of a cephalosporin with an aminoglycoside, e.g. rocephin 2 g/day i.v. with refobacin 1 time/day 240 mg i.v. or combination of vancomycin (e.g. Vanco-Cell) 2 time/day 1 g i.v. with gentamicin (see above).
Progression/forecastThis section has been translated automatically.
LiteratureThis section has been translated automatically.
- Bonner C et al (2001) Fournier gangrene as a rare complication after stapler hemorrhoidectomy. Case report and review of the literature. Surgeon 72: 1464-1466
- Eke N et al (2000) Fournier's gangrene: a review of 1726 cases. Br J Surg 87: 718-728
- Ekelius L et al (2004) Fournier's gangrene after genital piercing. Scand J Infect Dis 36:610-612.
- Fournier JA (1883) Gangrène foudroyante de la verge. La semaine médicale (Paris) 3: 345
- Pediment GD (2002) Comment on Ch. Bonner et al.: Fournier gangrene as a rare complication after stapler hemorrhoidectomy. Surgeon 73: 288
- Kilic A (2001) Fournier's gangrene: etiology, treatment, and complications. Ann Plast surgery 47: 523-527
- McCormack M et al (2015) Fournier's gangrene: A retrospective analysis of 26 cases in a Canadian hospital and literature review. Can Urol Assoc J 9:E407-410
- Maguina P et al (2003) Split thickness skin grafting for recreation of the scrotum following Fournier's gangrene. Burns 29: 857-862
- Merino E (2002) Fournier's gangrene in HIV-infected patients. Eur J Clin Microbiol Infect Dis 20: 910-913
- Morpurgo E, Galandiuk S (2002) Fournier's gangrene. Surg Clin North Am 82: 1213-1224
- Nisbet AA, Thompson IM (2002) Impact of diabetes mellitus on the presentation and outcomes of Fournier's gangrene. Urology 60: 775-779
- Rouzrokh M et al (2014) Fournier's Gangrene in Children: Report on 7 Cases and Review of Literature. Iran J Pediatr 24:660-661
- Xeropotamos NS et al (2002) Fournier's gangrene: diagnostic approach and therapeutic challenge. Eur J Surg 168: 91-95
- Yılmazlar Tet al. (2014) Fournier's gangrene: review of 120 patients and predictors of mortality. Ulus Travma Acil Cerrahi Derg 20:333-337
Incoming links (6)Cytomegalovirus ulcer; Erysipelas gangraenosum genitalium; Fasciitis necrotizing; Gangraenosum ulcer; Genital gangrene, acute ulcerous; Piercing;
Outgoing links (9)Aminoglycosides; Ampicillin; Antibiotics; Cefotaxime; Cytomegalovirus ulcer; Fasciitis necrotizing; Fournier gangrene; Gentamicin; Streptococcus;
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.