Rare but very serious, Fournier’s gangrene is a perineal or genital necrotizing disease. Men are 10 times more affected than women. This gangrene requires rapid treatment because the mortality rate is high.
What is Fournier’s gangrene?
Fournier’s gangrene is a acute bacterial necrotizing dermohypodermatitis or perineal or genital necrotizing fasciitis. It thus leads to the progressive destruction of all cutaneous and subcutaneous tissues which necrotize down to the muscular fascia.
What causes Fournier’s gangrene?
This gangrene is secondary to a polymicrobial infection by aerobic and anaerobic bacteria. According to the association Urofrancealthough several of the cases described are idiopathic, that is, the disease has no known cause, “the etiology is identified in 75 to 100% of patients. She is colorectal (a anal fistula for example) in 13 to 50% of cases and urogenital (urinary tract infection) in 17 to 87% of cases“. Dr. Maxime Vallée, urological surgeon, also recalls that the cause may be linked to a perineal trauma or to a unsupported skin wound. “Fournier’s gangrene usually occurs in already frail patients : diabetics, obese, alcohol-dependent, malnourished, immunocompromised etc… “, he explains. Men are 10 times more affected than the woman by this gangrene.
Whatever the cause, this gangrene generally begins with a local, genital, perineal or perianal infectionwhich expands rapidly if not properly supported. The infection itself often begins as a cellulitisthat is to say that the area begins to swell, to become erythematous and painful with very quickly the appearance of necrotic areas with sometimes “snowy” crepitations on skin palpation confirming the disease.
What are the symptoms ?
“There is sometimes a significant discrepancy between the very often marked general picture and the patient’s complaints even if significant perineal pain is the rule“says Dr. Vallée. Indeed, the symptoms of Fournier’s gangrene involve an often noisy infectious picture with a significant perineal pain, fever, severe fatigue, confusion. This may progress to septic shock.
Is it contagious ?
No, Fournier’s gangrene is not contagious.
The surgery is systematic.
What is the treatment for Fournier’s gangrene?
According to the urologist, the treatment has three components:
► The first component is infectious, with the establishment of a broad-spectrum antibiotic therapy.
► At the same time, surgery is systematically necessary to achieve surgical debridement: remove dead tissue and recover healthy tissue. It will then be necessary to perform dressings every 24 to 48 hours at first to clean the area and try to sprout healthy tissue so that a healing process can begin but this is a long care often spanning several months.
► Finally, support in intensive care is often necessary, especially in the case of septic shock. This care aims to control the infection and all the organ decompensation that this can induce (kidney, liver failure, etc.)
The mortality rate is around 20 to 30%
What is the prognosis?
In 2008, the medical literature on the subject indicated that the mortality rate was relatively high: around 20 to 80% of cases, “often due to the delay in diagnosis and management“. A more recent paper (2018) from the National library of medicine, states that “despite advances in techniques and modalities of anesthesia resuscitation mortality remains high, around 20 to 30%“.
What are the consequences?
“The sequelae can be cutaneous, muscular or of a sexual nature (erection). The presence of incontinence or an anal or urinary fistula sometimes requires performing a digestive or urinary stoma (a diversion of the digestive tract or urinary tract at the level of the skin of the abdomen to evacuate stools or urine towards a pocket outside the body)“, develops Dr. Maxime Vallée.
What are the complications?
Complications directly related to gangrene are those cited above. Other complications, which are not related to the infection itself exist. In intensive care, the patient, by remaining lying down for so long, can make a pulmonary embolism for example. “Complications are mostly linked to the underlying pathologies specific to each patient (diabetes, alcohol dependence, etc.) and which must at all costs be supported to improve survival and recovery of the patient.”
Thanks to Dr Maxime Vallée, urologist, member of the infectiology committee of the French Association of Urology.
Sources:
– Urofrance, French Association of Urology
– National Library of Medicine