Fournier’s gangrene

Abstract

The French venereologist Jean Alfred Fournier reported the fi rst small series of a rapidly progressive gangrene of the penis and scrotum in fi ve young men in 1883. The underlying polymicrobial necrotizing fasciitis starts in the perineal, perianal, or genital areas and can extend up to the abdominal and lumbar wall. It is most common in older men in the 5th-6th decades and associated with diseases which precondition an immunodefi ciency status like diabetes mellitus, malnutrition, chronic alcoholism, and malignant or infectious diseases. Although the incidence is low and accounts for less than 0.5 % of all admissions to urologic clinics, the incidence is rising due to an increase of older people with higher comorbidities and limited immunologic status [ 1 ]. The restricted immunity together with an anorectal, urogenital, or perineal trauma is often associated with recent instrumentation and enables microorganisms, such as Enterobacteriaceae; anaerobic, streptococcal, and staphylococcal species; or fungi, to promote the fulminant infection of a Fournier’s gangrene [ 2 ]. Especially, synergistic polymicrobial effects lead to a rapid spread along the superfi cial and deep fascial planes. Gangrenous necrosis of the fascia is followed by the involvement of adjacent subcutaneous and skin tissue [ 3 ]. Delayed treatment leads to a rapid systemic progression with fulminant sepsis, multiorgan failure, and high mortality of up to 70 % despite rapid operation and modern intensive care therapy [ 4 ].