The first signs of Fournier gangrene (also known as cutaneous necrotizing fasciitis) stem from the invasion of bacterial microorganisms from other sources into the scrotal or perineal areas [1] [2] [3]. The lower gastrointestinal system (the colon and the rectum), the urogenital system, and the skin are listed as the most important sources of bacterial spread, with perianal abscesses, appendicitis, infection of the Bartholin's gland, coital injury, and episiotomy-induced wound infections being the main portals of entry [2] [3]. The most common pathogens are Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Bacteroides fragilis; many studies, however, highlight the polymicrobial nature of Fournier gangrene [1] [4]. The clinical presentation is distinguished by an abrupt onset of fever (often > 38°C) accompanied by severe pain in the scrotal, perineal, or perianal region [1] [2] [3] [5]. Marked localized swelling is observed in most cases and frequently produces a purulent discharge with a foul odor [1] [2] [3] [5]. Crepitus is also observed in the majority of patients [1] [2] [3]. Fournier gangrene poses a significant risk to the individual's life due to the rapid spread of infection into distant tissues, leading to sepsis and systemic signs of tachycardia and multiorgan failure [1] [2] [3]. Mortality rates have been established to be as high as 20-30% [6], meaning that an early diagnosis is of essential importance.

• Swelling

  The swelling of subcutaneous plane involved the flank regions, mainly on the left side. The investigations were performed (full blood count, blood urea, electrolytes, coagulation profile). [ncbi.nlm.nih.gov]

  Marked localized swelling is observed in most cases and frequently produces a purulent discharge with a foul odor. Crepitus is also observed in the majority of patients. [symptoma.com]

  A 46-year-old man with uncontrolled type 2 diabetes and alcoholic liver disease presented to the emergency department with painful swelling in the scrotum and perianal region. [nejm.org]

• Turkish

  Resulting mortality increases in individuals lacking access not only to pragmatic resources such as sanitation and medical care, but to psychosocial resources, as well.A 2006 Turkish study reported 46% of those diagnosed with Fourniers had elevated blood [en.wikipedia.org]

  […] inpatient mortality was 4.7%. [5] Factors associated with high mortality include an anorectal source, advanced age, extensive disease (involving abdominal wall or thighs), shock or sepsis at presentation, renal failure, and hepatic dysfunction. [57] In a Turkish [emedicine.medscape.com]

• Enuresis

  In anecdotes, Fournier described recognized causes of perineal gangrene, including placement of a mistress’ ring around the phallus, ligation of the prepuce (used in an attempt to control enuresis or as an attempted birth control technique practiced by [emedicine.medscape.com]

• Rectal Mass

  Following acute management a thorough examination including digital rectal examination was performed which detected an extensive rectal mass with extension of necrotic points to the anal area. [casesjournal.biomedcentral.com]

• Liver Dysfunction

  Diverse factors predispose to Fournier gangrene, such as diabetes mellitus, ethylism, liver dysfunction, haematological disorders, obesity or recent regional instrumentation. [ncbi.nlm.nih.gov]

• Cardiomegaly

  In addition there was morbid obesity (body mass index 46.9), cirrhosis of the liver, and marked focal coronary artery atherosclerosis with significant cardiomegaly. [ncbi.nlm.nih.gov]

• Erythema

  Examination of the patient's perineum was consistent with Fournier's gangrene and included significant erythema, edema, and calor of the penis and scrotum with a large malodorous eschar. [hindawi.com]

  Physical examination revealed edema (91.4%), erythema (88.6%) and perineal skin necrosis (60%). All the patients underwent surgical debridement of necrotic tissue. In 54.3% reoperations were necessary for new surgical debridements. [ncbi.nlm.nih.gov]

  Fournier's gangrene: A horrendous infection of the genitalia that causes severe pain in the genital area (in the penis and scrotum or perineum) and progresses from erythema (redness) to necrosis (death) of tissue. Gangrene can occur within hours. [medicinenet.com]

  […] promote anaerobes and cause rapid dissemination Obliterative endarteritis plays a key role in pathogenesis Diagrams / tables Images hosted on other servers: Fournier gangrene severity index Clinical features Patients present with genital induration, pain, erythema [pathologyoutlines.com]

The diagnosis of Fournier gangrene rests on a thorough patient history and a detailed physical examination [2] [3]. During the interview, the physician should obtain information regarding the onset of symptoms and their progression, whereas assessment of risk factors is crucial for determining the risk of complications. Diabetes mellitus, HIV infection, and alcohol abuse are some of the principal comorbidities that significantly elevate the risk for the development of Fournier gangrene, meaning that their presence should be taken into consideration [1]. Furthermore, recent instrumentation (such as catheterization, urogenital or colonic biopsy, gynecological procedures, genital piercing, trauma, recent delivery or septic abortion) have also been implicated in the pathogenesis [1] [2] [3]. A full examination of the genital and perineal areas can reveal the typical features of an advanced infection and is perhaps the crucial component of the workup. Although Fournier gangrene is primarily a clinical diagnosis, various laboratory and imaging studies may be employed. A complete blood count (showing anemia, thrombocytopenia, and leukocytosis), glucose abnormalities (both hyperglycemia and hypoglycemia can be detected), impaired kidney function parameters (creatinine and urea), as well as hypoalbuminemia are nonspecific findings, whereas arterial blood gases (ABGs), a full coagulation panel, serum electrolytes (sodium and potassium) and samples for microbiological investigations (mainly cultures) should be obtained as well [1] [3] [5]. Radiography, ultrasonography, and computed tomography (CT) might be useful for evaluating the abdomen and the perineal area [1] [2] [3] [5].

The patients' age, sex, predisposing factors, duration of symptoms and hospital stay, time to operation, size of the skin defect, bacteria isolated, treatment modalities, and outcomes were reviewed. [ncbi.nlm.nih.gov]

Fournier’s gangrene: can aggressive treatment save life? Int Urol Nephrol 2001;33:533–536 PubMed CrossRef Google Scholar 16. Korhonen K, Hirn M, Niinikoski J. Hyperbaric oxygen in the treatment of Fournier’s gangrene. [dx.doi.org]

The aim of this study was to analyze the prognosis and treatment effectiveness of this fulminant infectious disease. Forty-one patients were admitted to our hospital with the diagnosis of Fournier gangrene between January 1998 and December 2006. [ncbi.nlm.nih.gov]

It is considered a urological emergency with a poor prognosis due to its high mortality rate (ranging ~15-50% 3 ). [radiopaedia.org]

Although there were no etiological factors in 25 patients (71%), various etiological factors were found in 10 patients (29%). Multiple debridements were performed in the majority of the cases. The overall mortality rate was 40%. [ncbi.nlm.nih.gov]

Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene. [doi.org]

Fourniers gangrene: population based epidemiology and outcomes. [ncbi.nlm.nih.gov]

Its epidemiology has changed and is much different from the origin. It affecting mostly men between 50 and 60 years of age. This disease also affects females. [casesjournal.biomedcentral.com]

An overview is given for each, including causes, pathophysiology, diagnosis, treatment, and new developments. The focus for priapism is on diagnosis and distinguishing high-flow from low-flow forms, as the latter requires emergent treatment. [ncbi.nlm.nih.gov]

Abstract Despite advances in the evaluation, treatment, and pathophysiological understanding of necrotizing soft-tissue infections, Fournier's gangrene remains a life-threatening urological emergency. [nature.com]

Pathophysiology Localized infection adjacent to a portal of entry is the inciting event in the development of Fournier gangrene. [emedicine.medscape.com]

Prevention and early diagnosis are essential. Prompt aggressive intervention is warranted to maximize outcomes. [ncbi.nlm.nih.gov]

Can You Prevent It? There are some steps you can take to lower your chances of getting Fournier’s gangrene: If you have diabetes, check your genitals and surrounding areas for wounds or signs of infection, as well as for swelling or drainage. [webmd.com]

Women who have had a pus-producing bacterial infection (abscess) in the vaginal area, a surgical incision in the vagina and perineum to prevent tearing of skin during delivery of a child (episiotomy), an abortion resulting in fever and an infection of [healthcommunities.com]

1. Thwaini A, Khan A, Malik A, et al. Fournier’s gangrene and its emergency management. Postgrad Med J. 2006;82(970):516-519.
2. Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol. 2015;7(4):203-215.
3. Mallikarjuna MN, Vijayakumar A, Patil VS, Shivswamy BS. Fournier’s Gangrene: Current Practices. ISRN Surg. 2012;2012:942437.
4. Eke N. Fournier's gangrene: a review of 1726 cases. Br J Surg. 2000;87(6):718-728.
5. Chen SY, Fu JP, Wang CH, Lee TP, Chen SG. Fournier gangrene: a review of 41 patients and strategies for reconstruction. Ann Plast Surg. 2010;64(6):765-769.
6. Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier's gangrene. A clinical review. Arch Ital Urol Androl. 2016;88(3):157-164.