Ver el código de «Fournier gangrene»

==Background==
*Necrotizing fasciitis of the perineum, genitalia, and/or perianal area
*A '''life-threatening surgical emergency''' with mortality 20-40%<ref name="eke">Eke N. Fournier's gangrene: a review of 1726 cases. ''Br J Surg''. 2000;87(6):718-728. PMID 10848848.</ref>
*Polymicrobial infection: aerobic + anaerobic organisms (E. coli, Bacteroides, Streptococcus, Clostridium, S. aureus)
*Rapidly progressive — tissue destruction can advance centimeters per hour
*Source: perianal (most common), urogenital, or cutaneous infection

==Risk Factors==
*Diabetes mellitus (present in 40-60% of cases)
*Immunosuppression (HIV, malignancy, chemotherapy, transplant)
*Obesity
*Chronic alcohol use
*Peripheral vascular disease
*Perianal abscess, urethral stricture, urinary tract instrumentation
*Recent surgery or trauma to the perineum

==Clinical Features==
*Severe perineal/genital pain (often out of proportion to examination findings early on)
*Erythema, edema, and tenderness of perineum/scrotum/vulva
*Rapid progression: skin changes from erythema → dusky → bullae → necrosis → gangrene
*Crepitus on palpation (subcutaneous gas — pathognomonic but not always present)
*Fever, tachycardia, systemic toxicity / [[Sepsis (main)|septic shock]]
*Scrotal swelling with disproportionate pain
*May appear deceptively benign early in the course

==Evaluation==
*'''Clinical diagnosis''' — do not delay surgical consultation for imaging
*Labs: CBC (leukocytosis often >15,000), BMP, lactate, blood cultures, CRP
*CT with contrast: subcutaneous gas, fascial thickening, fat stranding, abscess formation
**CT has high sensitivity (~90%) but should not delay surgery<ref name="levenson">Levenson RB, et al. Fournier gangrene: role of imaging. ''Radiographics''. 2008;28(2):519-528. PMID 18349455.</ref>
*LRINEC score may help risk-stratify (see [[LRINEC score calculator]])
*X-ray: may show subcutaneous emphysema

==Management==
*Emergent surgical debridement — the single most important intervention
**Often requires multiple return trips to OR for serial debridement
**Early surgery correlates with decreased mortality
*Broad-spectrum IV antibiotics
**Vancomycin (or Linezolid) +
**Piperacillin-tazobactam (or Meropenem) +
**Clindamycin (for toxin suppression and synergistic coverage)
*Aggressive IV fluid resuscitation and vasopressors for [[Septic shock|septic shock]]
*Tetanus prophylaxis
*Wound care: vacuum-assisted closure (VAC) after debridement
*Consider hyperbaric oxygen therapy (HBO) as adjunct (limited evidence)

==Disposition==
*ICU admission with emergent surgical consultation
*Urology and/or general surgery
*High mortality — early recognition and aggressive surgery are key

==See Also==
*[[Necrotizing fasciitis]]
*[[Perianal abscess]]
*[[Testicular torsion]]
*[[Septic shock]]

==References==
<references/>

[[Category:Infectious Disease]]
[[Category:Urology]]
[[Category:Surgery]]