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Fournier Gangrene, Emergency Medicine

Gary M. Vilke Reviewed 06/2017
 


Basics

Description

  • Inadequate hygiene leads to scrotal skin maceration and excoriation:

    • Portal of entry for bacteria in tissue

  • Once skin barrier is broken, polymicrobial flora spread along fascial planes...

Diagnosis

Signs and Symptoms

  • Rapidly progressive necrotizing infection of perineum involving subcutaneous and fascial tissues and often muscle layers:

    • Usually seen in diabetics or immunocompromised pati...

Treatment

Pre-Hospital

Patients may be hypotensive from septic shock and require aggressive fluid resuscitation and vasopressor support. 

Initial Stabilization/Therapy

  • Manage airway and resuscitate as in...

Follow-Up

Disposition

Admission Criteria

  • All patients with Fournier gangrene require admission and surgical ICU care.

  • Mortality estimates of 3–38% emphasize need for early aggressive care.

  • Consider early ...

Pearls and Pitfalls

  • Failure to perform a careful genital exam, particularly in a pediatric patient

  • Failure to initiate antibiotics in a timely manner

Additional Reading

  • Burch  DM, Barreiro  TJ, Vanek  VW. Fournier's gangrene: Be alert for this medical emergency. JAAPA.  2007;20(11):44–47.

  • Davis  JE, Silverman  M. Scrotal emergencies. Emerg Med ...

Codes

ICD9

608.83 Vascular disorders of male genital organs 

ICD10

N49.3 Fournier gangrene 

SNOMED

  • 398318005 Fournier's gangrene

  • 236782005 Fournier's gangrene of scrotum

  • 397900003 Fournier's gangrene of peni...

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