What is Fournier's gangrene?

What is Fournier's Gangrene?

Fournier's gangrene is a life-threatening necrotizing fasciitis of the external genitalia, perineum, and perianal regions that represents a surgical emergency requiring immediate recognition and intervention. 1

Core Definition and Pathophysiology

Fournier's gangrene is a rapidly progressive polymicrobial infection involving both aerobic and anaerobic bacteria that causes tissue necrosis through a specific pathophysiologic cascade 1:

• The infection begins when commensal bacteria gain entry into the perineum through a portal of entry, triggering an inflammatory response that leads to obliterative endarteritis with thrombosis of surrounding vessels 1
• Vascular compromise causes tissue ischemia, which promotes further anaerobic bacterial proliferation and accelerates tissue destruction 1
• The infection can extend cranially to the abdominal wall and caudally to the legs via the superficial perineal fascia 1

Microbiology

• The infection is typically polymicrobial, involving aerobic organisms (Streptococcus species, Staphylococcus species, Escherichia coli) and anaerobic bacteria working synergistically 1, 2

Clinical Presentation

The World Journal of Emergency Surgery identifies key cutaneous manifestations to assess 3:

• Erythema, subcutaneous crepitations, patches of gangrene, foul smell, purulence/wound discharge, and tenderness to palpation 3
• Evaluation must identify potential portals of entry from anorectal (45.8% of cases), genitourinary, or local cutaneous sources 1, 3

Epidemiology and Risk Factors

• Predominantly affects males with a male-to-female ratio of 42:1, with a mean age of presentation at 51 years 1
• Overall incidence is approximately 1.6 cases per 100,000 males annually, accounting for less than 0.02% of all hospital admissions 1
• Diabetes mellitus is the major predisposing factor, with obesity commonly associated 1
• Other risk factors include conditions causing impaired host resistance and reduced cellular immunity, such as leukemia, HIV, chronic alcoholism, and other immunocompromising conditions 1, 4, 5

Mortality

• Mortality rates vary widely, ranging from 7.5% to as high as 88% in some studies, with contemporary series reporting 20-50% mortality 1, 3, 4, 5
• The high mortality rate underscores the critical importance of early recognition and immediate surgical intervention 1