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Scrotal Gangrene

Presentation

Four cases of recreation of the scrotum with meshed split thickness skin grafts (STSG) are presented. The discussion includes a comparison of STSG with other treatment options. [ucdavis.pure.elsevier.com]

We report on 3 heroin abusers who presented with localized gangrene of the genitalia after injection into the femoral vessels. [ncbi.nlm.nih.gov]

The perineum presents an ample anastomotic network of blood vessels, similar to the face, which allows for the establishment of several flaps. [rbcp.org.br]

Fournier's Gangrene Presenting as Gas-forming Subcutaneous Infection of the Scrotum. Scand J Urol Nephrol. 1983;17(2):245-7. PubMed PMID: 6612244. TY - JOUR T1 - Fournier's gangrene presenting as gas-forming subcutaneous infection of the scrotum. [unboundmedicine.com]

Patients presenting with acquired immunodeficiency syndrome also present a higher predisposition to the disease (2). [scielo.br]

Skin

  • Skin Thickening

    In more advanced cases, US can demonstrate that this skin thickening and subcutaneous air extends posteriorly to include the perineum and buttocks. [pubs.rsna.org]

    Instead the ultrasound characteristics of Fournier’s gangrene include marked thickening of scrotal skin and, most significantly, air in the subcutaneous tissues. [intechopen.com]

Breast

  • Agalactia

    S. agalactiae, S. haemolyticus, E. coli, and peptostreptococci were identified in the pus in our patient. S. agalactiae belongs to group B streptococci and is one of the resident flora in the human vagina. [jmedicalcasereports.biomedcentral.com]

Neurologic

  • Meningism

    It is less virulent than members of group A streptococci but has received more attention because it can cause suppurative meningitis or sepsis in newborns and is an opportunistic pathogens in adults [11]. [jmedicalcasereports.biomedcentral.com]

Urogenital

  • Scrotal Pain

    The differential in the setting of acute scrotal pain includes: epididymo-orchitis testicular torsion testicular trauma scrotal cellulitis/abscess Promoted articles (advertising) [radiopaedia.org]

    In this case, pain and swelling involve both the scrotal contents and the groin area. [auanet.org]

    Upon further questioning, he also endorsed severe scrotal pain and swelling and frequent masturbation with soap as a lubricant. [hindawi.com]

    Unlike other conditions that cause acute scrotal pain, in Fournier’s gangrene the scrotal contents- the testes and epididymides- are normal, and no masses or other abnormal structures are present. [intechopen.com]

  • Scrotal Ulcer

    We present a typical case of this extremely rare disease affecting a 16-year-old boy in whom the scrotal ulcerations were preceded by an episode of pharyngitis with fever. [ncbi.nlm.nih.gov]

    ulceration from pressure and inadequate perianal hygiene. [uspharmacist.com]

  • Painless Testicular Mass

    A firm and often painless testicular mass is detected at birth, with or without skin discoloration and edema. Necrotizing fasciitis in neonates is extremely rare and is associated with almost 50% mortality [2]. [jmedicalcasereports.biomedcentral.com]

Treatment

The discussion includes a comparison of STSG with other treatment options. [ucdavis.pure.elsevier.com]

A three pronged treatment strategy consisting of antibiotic coverage for aerobes and anaerobes, general supportive measures and surgical debridement is usually applied [4]. [academic.oup.com]

The correct time for initiating surgery is important in the treatment of these patients 12. [rbcp.org.br]

Arch Ital Urol Androl 2016; 88(3):157-164. necrotizing fasciitis aetiology associations pathogenesis clinical features investigations treatment [gpnotebook.com]

Prognosis

Deciding factors to be considered include the gangrene being dry and not wet in nature, extent of the gangrene and also the overall prognosis of the patient. [anncaserep.com]

Despite the rarity of this disease, unfavorable prognosis related to this disease depends much on the timing of medical care. [karger.com]

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

Outlook / Prognosis What is the prognosis (outlook) for Fournier’s gangrene? Fournier’s gangrene is life-threatening — as many as 50% of people with Fournier’s gangrene die because of it. [my.clevelandclinic.org]

Prognosis of Fournier's Gangrene Mortality of Fournier's gangrene is around 20%. Risk factors of increased mortality are diabetes mellitus, alcoholism and colorectal origin of Fournier's gangrene (often delayed diagnosis and extensive infection). [urology-textbook.com]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

However, we believe this is an oversight because the etiology and pathology of this rare entity is not completely unknown. [ijri.org]

The etiology, pathology, bacteriology and treatment of Fournier's gangrene are discussed. [unboundmedicine.com]

Tissue samples taken during the first two debridements revealed that the microbiological etiology of FG was polymicrobial. [jmedicalcasereports.biomedcentral.com]

Fournier stated that there were three characteristic findings of this syndrome: sudden onset in young and healthy males, rapid progression, and absence of a specific etiologic agent 1. The etiology of this disease is controversial. [rbcp.org.br]

Epidemiology

Epidemiology Elderly adults (male and female), immunocompromised (particularly diabetes) or those with depressed mental status Sites Dartos and penile fascia are preferred sites Etiology 50 - 60% of infections have GI or GU source of infection Usually [pathologyoutlines.com]

"Fournier's gangrene: Population based epidemiology and outcomes". The Journal of Urology. 181 (5): 2120–6. doi : 10.1016/j.juro.2009.01.034. PMC 3042351. PMID 19286224. [en.wikipedia.org]

Ufimtseva MA, Malishevskaya NP, Syrneva TA: Clinical and epidemiological features of syphilis in the territories of the urals, siberia and the far east. Russian J Dermatovenereol 2009; 2: 68–73. Author Contacts Prof. M.A. [karger.com]

Epidemiological aspects of Fournier's gangrene at Kenyatta National Hospital, Nairobi. East Afr. Med. J. 75, 586–589 (1998). 9. Czymek, R. et al. New insights into the epidemiology and etiology of Fournier's gangrene: a review of 33 patients. [nature.com]

Pathophysiology

We postulate that the pathophysiology of this entity is related to arterial embolization of particulate matter into the microcirculation of the genitalia, which causes arterial thrombosis leading to localized gangrene. [ncbi.nlm.nih.gov]

This supports the pathophysiology of a general vasospastic effect on several end arteries. [anncaserep.com]

There are three possible pathophysiological mechanisms: local trauma, which would facilitate the entry of micro-organisms through injured skin; infection of the genitourinary tract, with extension to deep planes; and/or infection of the perineal or retroperitoneal [rbcp.org.br]

Symptoms and Pathophysiology The etiology of, and predisposing factors for, FG provide a favorable environment for infection. [uspharmacist.com]

Prevention

Prevention How can I prevent Fournier’s gangrene? Experts have not yet found a way to prevent Fournier’s gangrene. However, there are a few ways to reduce your risk of Fournier’s gangrene, or at least catch it early. [my.clevelandclinic.org]

Keeping diabetes under control can help prevent the condition Controlling overweight and obese body conditions can help reduce the risk of this infection Avoiding alcohol: Avoiding the intake of alcohol reduces or prevents the risk of Fournier's Gangrene [dovemed.com]

Prevention. To prevent gangrene in an open wound, the wound should be kept as clean as possible. [medical-dictionary.thefreedictionary.com]

It is a preventable condition to some extent. We are reporting here a case of Fournier's gangrene in a 25-day-old male neonate who was treated aggressively with broad-spectrum antibiotics and early surgical debridement. [jcnonweb.com]

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