Fournier gangrene - Revision history

Danbot: Strip excess bold

2026-03-22T09:36:13Z

Strip excess bold

← Revisión anterior		Revisión del 09:36 22 mar 2026
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	==Clinical Features==		==Clinical Features==
	*Severe perineal/genital pain (often ~~'''~~out of proportion~~'''~~ to examination findings early on)		*Severe perineal/genital pain (often out of proportion to examination findings early on)
	*Erythema, edema, and tenderness of perineum/scrotum/vulva		*Erythema, edema, and tenderness of perineum/scrotum/vulva
	*Rapid progression: skin changes from erythema → dusky → bullae → necrosis → gangrene		*Rapid progression: skin changes from erythema → dusky → bullae → necrosis → gangrene
	*~~'''~~Crepitus~~'''~~ on palpation (subcutaneous gas — pathognomonic but not always present)		*Crepitus on palpation (subcutaneous gas — pathognomonic but not always present)
	*Fever, tachycardia, ~~'''~~systemic toxicity~~'''~~ / [[Sepsis (main)\|septic shock]]		*Fever, tachycardia, systemic toxicity / [[Sepsis (main)\|septic shock]]
	*Scrotal swelling with disproportionate pain		*Scrotal swelling with disproportionate pain
	*May appear deceptively benign early in the course		*May appear deceptively benign early in the course
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	==Evaluation==		==Evaluation==
	*'''Clinical diagnosis''' — do not delay surgical consultation for imaging		*'''Clinical diagnosis''' — do not delay surgical consultation for imaging
	*~~'''~~Labs~~'''~~: CBC (leukocytosis often >15,000), BMP, lactate, blood cultures, CRP		*Labs: CBC (leukocytosis often >15,000), BMP, lactate, blood cultures, CRP
	*~~'''~~CT with contrast~~'''~~: subcutaneous gas, fascial thickening, fat stranding, abscess formation		*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>		**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]])		*LRINEC score may help risk-stratify (see [[LRINEC score calculator]])
	*X-ray: may show subcutaneous emphysema		*X-ray: may show subcutaneous emphysema

	==Management==		==Management==
	*~~'''~~Emergent surgical debridement~~'''~~ — the single most important intervention		*Emergent surgical debridement — the single most important intervention
	**Often requires multiple return trips to OR for serial debridement		**Often requires multiple return trips to OR for serial debridement
	**Early surgery correlates with decreased mortality		**Early surgery correlates with decreased mortality
	*~~'''~~Broad-spectrum IV antibiotics~~'''~~		*Broad-spectrum IV antibiotics
	**~~'''~~Vancomycin~~'''~~ (or Linezolid) +		**Vancomycin (or Linezolid) +
	**~~'''~~Piperacillin-tazobactam~~'''~~ (or Meropenem) +		**Piperacillin-tazobactam (or Meropenem) +
	**~~'''~~Clindamycin~~'''~~ (for toxin suppression and synergistic coverage)		**Clindamycin (for toxin suppression and synergistic coverage)
	*Aggressive IV fluid resuscitation and vasopressors for [[Septic shock\|septic shock]]		*Aggressive IV fluid resuscitation and vasopressors for [[Septic shock\|septic shock]]
	*Tetanus prophylaxis		*Tetanus prophylaxis
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	==Disposition==		==Disposition==
	*~~'''~~ICU admission~~'''~~ with emergent surgical consultation		*ICU admission with emergent surgical consultation
	*Urology and/or general surgery		*Urology and/or general surgery
	*High mortality — early recognition and aggressive surgery are key		*High mortality — early recognition and aggressive surgery are key

Danbot: Major expansion: antibiotic regimen, LRINEC reference, CT findings, surgical emphasis, references

2026-03-21T18:36:49Z

Major expansion: antibiotic regimen, LRINEC reference, CT findings, surgical emphasis, references

← Revisión anterior		Revisión del 18:36 21 mar 2026
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	==Background==		==Background==
	~~[[File:Gray1144.png\|thumb\|Scrotal anatomy]]~~		*Necrotizing fasciitis of the perineum, genitalia, and/or perianal area
	~~[[File:Figure 28 01 02.jpg\|thumb\|Scrotal anatomy]]~~		*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>
	*~~Life-threatening polymicrobial necrotizing~~ fasciitis of perineum, genitalia, or perianal area.		*Polymicrobial infection: aerobic + anaerobic organisms (E. coli, Bacteroides, Streptococcus, Clostridium, S. aureus)
	**Mostly bacteria lower GI system - ~~[[B. fragilis]] and [[E. coli]]~~		*Rapidly progressive — tissue destruction can advance centimeters per hour
	**Obliterative endarteritis of subcutaneous arterioles leads to gangrene of overlying skin<ref name="~~Shyam~~">~~Shyam DC, Rapsang AG~~. Fournier's gangrene. ~~Surgeon~~. ~~2013 Aug~~;11(4):~~222~~-32. ~~doi: 10.1016/j.surge.2013.02.001~~.</ref>		*Source: perianal (most common), urogenital, or cutaneous infection
	*~~Mortality - often cited as 20-40%~~, ~~but up to 80% in some studies<ref name="Concepts" />~~

	===Risk Factors===		==Risk Factors==
	*[[Diabetes mellitus]] (~~most common~~)		*Diabetes mellitus (present in 40-60% of cases)
	*~~[[Hypertension]]~~		*Immunosuppression (HIV, malignancy, chemotherapy, transplant)
	*~~[[Alcoholism]]~~		*Obesity
	*~~Advanced age~~		*Chronic alcohol use
	*~~Para/Quadriplegic~~		*Peripheral vascular disease
	*~~Males>Females (10:1)<ref name="Shyam" />~~, ~~(likely under-diagnosed in women<ref name="Concepts">Wróblewska M et al. Fournier's gangrene: current concepts. Pol J Microbiol. 2014;63(3):267-73.</ref>)~~		*Perianal abscess, urethral stricture, urinary tract instrumentation
			*Recent surgery or trauma to the perineum

	==Clinical Features==		==Clinical Features==
	~~[[File:Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier~~'~~s Gangrene with classic spotted area~~ of ~~ecchymosis (right lower scrotum~~) and ~~draining lesion~~ (~~mid scrotum). Draining lesions are~~ not always present ~~initially and even small areas of ecchymosis should be considered highly concerning for Fournier~~'~~s Gangrene.]]~~		*Severe perineal/genital pain (often '''out of proportion''' to examination findings early on)
	~~[[File:Fournier-Gangrene.png\|thumb\|Progression of Fournier~~'~~s Gangrene to larger draining lesion.]]~~		*Erythema, edema, and tenderness of perineum/scrotum/vulva
	[[~~File:PMC3560168 JCAS-5-273-g004.png~~\|~~thumb\|Fournier's Gangrene~~]]		*Rapid progression: skin changes from erythema → dusky → bullae → necrosis → gangrene
	*~~Initial event is usually local trauma or extension of a UTI or perianal infection<ref name="Shyam" />~~		*'''Crepitus''' on palpation (subcutaneous gas — pathognomonic but not always present)
	**Gangrene develops over 2-7 days		*Fever, tachycardia, '''systemic toxicity''' / [[Sepsis (main)\|septic shock]]
	*Marked pain~~, localized swelling, crepitus, ecchymosis to genital or perineal area.~~		*Scrotal swelling with disproportionate pain
	*~~Fever~~		*May appear deceptively benign early in the course
	*Malodorous purulent drainage
	*In late or severe cases, patient may present in ~~septic shock~~

	~~==Differential Diagnosis==~~
	~~{{Template:Testicular DDX}}~~

	==Evaluation==		==Evaluation==
	~~===Work-up===~~		*'''Clinical diagnosis''' — do not delay surgical consultation for imaging
	*CBC ~~- very elevated~~ leukocytosis		*'''Labs''': CBC (leukocytosis often >15,000), BMP, lactate, blood cultures, CRP
	*CMP - hyponatremia		*'''CT with contrast''': subcutaneous gas, fascial thickening, fat stranding, abscess formation
	*ESR		**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>
	*CRP		*'''LRINEC score''' may help risk-stratify (see [[LRINEC score calculator]])
	*~~Lactate~~		*X-ray: may show subcutaneous emphysema
	*Type and Screen
	*Wound Culture
	*~~Blood Cultures~~
	*CT ~~Abdomen/pelvis~~ (~~only if diagnosis unclear or if requested by~~ surgery~~/urology)~~

	=~~==Evaluation===~~
	*Clinical diagnosis, ~~based on history and physical exam~~
	*LRINEC score ~~here:~~ [[~~Necrotizing fasciitis~~]]

	==Management==		==Management==
	*~~Immediate surgery and urology consult for~~ surgical debridement ~~(gangrene can spread at rate of 2-3 cm/hr<ref name="Shyam" />)~~		*'''Emergent surgical debridement''' — the single most important intervention
	*~~[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]]~~		**Often requires multiple return trips to OR for serial debridement
	**~~[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr~~ '''OR''' ~~[[meropenem]] 500mg-1gm IV q8hr~~ '''OR''' ~~[[piperacillin-tazobactam]] 3.375gm to 4.5gm IV q6h~~) +~~/- ([[clindamycin]] 600mg-900mg IV q8h~~ '''OR''' ~~[[metronidazole]] 1gm IV then 500mg IV q8h~~)		**Early surgery correlates with decreased mortality
	**~~[[Piperacillin-Tazobactam]] 3.375-4.5g q6hr and [[linezolid]] 600mg q12hr is an alternative regimen<ref>Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines~~ for ~~the diagnosis~~ and ~~management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015 May 1;60(9~~)~~:1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52. doi:10.1093/cid/ciu444</ref>~~		*'''Broad-spectrum IV antibiotics'''
	*Aggressive ~~supportive care, including~~ fluid resuscitation (and [[~~Vasopressors~~\|~~pressors~~]]~~, if indicated~~)		**'''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==		==Disposition==
	*~~Admit to~~ ICU		*'''ICU admission''' with emergent surgical consultation
			*Urology and/or general surgery
			*High mortality — early recognition and aggressive surgery are key

	==See Also==		==See Also==
	*[[Necrotizing ~~Fasciitis~~]]		*[[Necrotizing fasciitis]]
	*[[~~Testicular Diagnoses~~]]		*[[Perianal abscess]]
	*[[~~Necrotizing Soft Tissue Infections~~]]		*[[Testicular torsion]]
	*[[~~EBQ:LRINEC Score~~]]		*[[Septic shock]]

	==References==		==References==
	<references/>		<references/>

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

Rossdonaldson1: /* Clinical Features */

2023-07-13T21:12:47Z

Clinical Features

← Revisión anterior		Revisión del 21:12 13 jul 2023
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	==Clinical Features==		==Clinical Features==
	[[File:Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic spotted area of ecchymosis (right lower scrotum) and draining lesion (mid scrotum). Draining lesions are not always present initially and even small areas of ecchymosis should be considered highly concerning for Fournier's Gangrene.]]		[[File:Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic spotted area of ecchymosis (right lower scrotum) and draining lesion (mid scrotum). Draining lesions are not always present initially and even small areas of ecchymosis should be considered highly concerning for Fournier's Gangrene.]]
	[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]		[[File:Fournier-Gangrene.png\|thumb\|Progression of Fournier's Gangrene to larger draining lesion.]]
	[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|~~ournier~~'s Gangrene]]		[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|Fournier's Gangrene]]
	*Initial event is usually local trauma or extension of a UTI or perianal infection<ref name="Shyam" />		*Initial event is usually local trauma or extension of a UTI or perianal infection<ref name="Shyam" />
	**Gangrene develops over 2-7 days		**Gangrene develops over 2-7 days

Rossdonaldson1: /* Clinical Features */

2023-07-13T21:11:58Z

Clinical Features

← Revisión anterior		Revisión del 21:11 13 jul 2023
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	==Clinical Features==		==Clinical Features==
	[[File:Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic.]]		[[File:Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic spotted area of ecchymosis (right lower scrotum) and draining lesion (mid scrotum). Draining lesions are not always present initially and even small areas of ecchymosis should be considered highly concerning for Fournier's Gangrene.]]
	[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]		[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]
	[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|ournier's Gangrene]]		[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|ournier's Gangrene]]

Rossdonaldson1: /* Clinical Features */

2023-07-13T21:09:40Z

Clinical Features

← Revisión anterior		Revisión del 21:09 13 jul 2023
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	==Clinical Features==		==Clinical Features==
	[[Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic.]]		[[File:Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic.]]
	[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]		[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]
	[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|ournier's Gangrene]]		[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|ournier's Gangrene]]

Rossdonaldson1: /* Clinical Features */

2023-07-13T21:09:16Z

Clinical Features

← Revisión anterior		Revisión del 21:09 13 jul 2023
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	==Clinical Features==		==Clinical Features==
			[[Thumbnail_IMG_9537.jpg\|thumb\|Early Fournier's Gangrene with classic.]]
	[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]		[[File:Fournier-Gangrene.png\|thumb\|Fournier's Gangrene]]
	[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|ournier's Gangrene]]		[[File:PMC3560168 JCAS-5-273-g004.png\|thumb\|ournier's Gangrene]]

Elcatracho: /* Management */

2021-02-09T01:37:02Z

Management

← Revisión anterior		Revisión del 01:37 9 feb 2021
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	*[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]]		*[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]]
	**[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr '''OR''' [[meropenem]] 500mg-1gm IV q8hr '''OR''' [[piperacillin-tazobactam]] 3.375gm to 4.5gm IV q6h) +/- ([[clindamycin]] 600mg-900mg IV q8h '''OR''' [[metronidazole]] 1gm IV then 500mg IV q8h)		**[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr '''OR''' [[meropenem]] 500mg-1gm IV q8hr '''OR''' [[piperacillin-tazobactam]] 3.375gm to 4.5gm IV q6h) +/- ([[clindamycin]] 600mg-900mg IV q8h '''OR''' [[metronidazole]] 1gm IV then 500mg IV q8h)
	*[[Piperacillin-Tazobactam]] 3.375-4.5g q6hr and [[linezolid]] 600mg q12hr is an alternative regimen<ref>Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52. doi:10.1093/cid/ciu444</ref>Aggressive supportive care, including fluid resuscitation (and [[Vasopressors\|pressors]], if indicated)		**[[Piperacillin-Tazobactam]] 3.375-4.5g q6hr and [[linezolid]] 600mg q12hr is an alternative regimen<ref>Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52. doi:10.1093/cid/ciu444</ref>
			*Aggressive supportive care, including fluid resuscitation (and [[Vasopressors\|pressors]], if indicated)

	==Disposition==		==Disposition==

Elcatracho: /* Management */

2021-02-09T01:36:40Z

Management

← Revisión anterior		Revisión del 01:36 9 feb 2021
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	*[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]]		*[[Antibiotics]] - Must cover [[gram positive]], [[gram negative]], and [[anaerobes]]
	**[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr '''OR''' [[meropenem]] 500mg-1gm IV q8hr '''OR''' [[piperacillin-tazobactam]] 3.375gm to 4.5gm IV q6h) +/- ([[clindamycin]] 600mg-900mg IV q8h '''OR''' [[metronidazole]] 1gm IV then 500mg IV q8h)		**[[Vancomycin]] + ([[imipenem]] 1gm IV q24hr '''OR''' [[meropenem]] 500mg-1gm IV q8hr '''OR''' [[piperacillin-tazobactam]] 3.375gm to 4.5gm IV q6h) +/- ([[clindamycin]] 600mg-900mg IV q8h '''OR''' [[metronidazole]] 1gm IV then 500mg IV q8h)
	*Aggressive supportive care, including fluid resuscitation (and [[Vasopressors\|pressors]], if indicated)		*[[Piperacillin-Tazobactam]] 3.375-4.5g q6hr and [[linezolid]] 600mg q12hr is an alternative regimen<ref>Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015 May 1;60(9):1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52. doi:10.1093/cid/ciu444</ref>Aggressive supportive care, including fluid resuscitation (and [[Vasopressors\|pressors]], if indicated)

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2020-06-04T20:33:02Z

Background

← Revisión anterior		Revisión del 20:33 4 jun 2020
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	[[File:Gray1144.png\|thumb\|Scrotal anatomy]]		[[File:Gray1144.png\|thumb\|Scrotal anatomy]]
	[[File:Figure 28 01 02.jpg\|thumb\|Scrotal anatomy]]		[[File:Figure 28 01 02.jpg\|thumb\|Scrotal anatomy]]
	~~[[File:Figure 28 01 03.jpg\|thumb\|Testicular anatomy]]~~
	*Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.		*Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.
	**Mostly bacteria lower GI system - [[B. fragilis]] and [[E. coli]]		**Mostly bacteria lower GI system - [[B. fragilis]] and [[E. coli]]

Rossdonaldson1: /* Background */

2020-06-04T20:32:40Z

Background

← Revisión anterior		Revisión del 20:32 4 jun 2020
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	==Background==		==Background==
			[[File:Gray1144.png\|thumb\|Scrotal anatomy]]
			[[File:Figure 28 01 02.jpg\|thumb\|Scrotal anatomy]]
			[[File:Figure 28 01 03.jpg\|thumb\|Testicular anatomy]]
	*Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.		*Life-threatening polymicrobial necrotizing fasciitis of perineum, genitalia, or perianal area.
	**Mostly bacteria lower GI system - [[B. fragilis]] and [[E. coli]]		**Mostly bacteria lower GI system - [[B. fragilis]] and [[E. coli]]