title: Fournier's gangrene.
abstract: Fournier's gangrene (FG) is a synergistic polymicrobial gangrenous infection of the perineum, scrotum and penis which is characterised by obliterative endarteritis of the subcutaneous arteries, resulting in gangrene of the subcutaneous tissue and the overlying skin. FG affects all ages and both genders, with a male preponderance. It is a rare but life-threatening disease, and despite therapeutic advances in recent years, the mortality rate is 3%-67%, with an incidence of 1:7500-1:750,000. Anorectal, genitourinary and cutaneous sources of infection are the most common causes of FG, with diabetes mellitus being the most common risk factor. The clinical condition presents evolution from 2 to 7 days and is characterised by uneasiness, local swelling and discomfort, fever, crepitus and sometimes frank septic shock. Current imaging techniques for initial evaluation of the disease include radiography, Ultrasonography (USG), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). However, the diagnosis of FG is usually clinical and imaging can be helpful in uncertain diagnosis and when clinical findings are ambiguous. Treatment of FG is based on a multimodal approach which includes intensive fluid resuscitation to stabilise the patient and correction of electrolyte imbalance, if any. This is followed by extensive debridements and resections in order to remove all necrotic and infected tissue, wide spectrum antibiotics and reconstructive surgery, whenever required. However, despite all the advances in treatment today, FG remains a surgical emergency, hence, early recognition with aggressive haemodynamic stabilisation, parenteral broad spectrum antibiotics and urgent surgical debridement are the mainstay of treatment.
authors.affiliation: Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, India. devajit_cs@yahoo.com
authors.forename: Devajit Chowlek
authors.initials: DC
authors.lastname: Shyam
authors.forename: Amy Grace
authors.initials: AG
authors.lastname: Rapsang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003646:Debridement / Q000379:methods*; D018934:Fournier Gangrene / Q000628:therapy*; D006801:Humans; D008297:Male; D010502:Perineum; D012611:Scrotum
chemical_list: D000900:Anti-Bacterial Agents
keywords: Aetiology; Complications; Fournier's gangrene; Necrotising fascitis; Pathogenesis; Treatment