Skip to main content
Log in

Fournier’s gangrene: Is it scrotal gangrene?

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Fournier’s gangrene was originally described as scrotal gangrene in young males. Today, it is generally accepted as synergistic necrotizing fasciitis of perineal, genital, or perianal regions, and the epidemiologic data have changed. However, there are still limited data about females due to the lack of female patients, even in large case series.

Methods

A retrospective review of the medical records of all patients who received surgery for emergency conditions over the past 22 years was performed to identify patients with Fournier’s gangrene. Data from these patients were then reviewed to determine the age, gender, etiology, causative bacteria, predisposing factors, treatment modalities, length of hospital stay, and morbidity and mortality rates associated with Fournier’s gangrene. Data were evaluated using multivariate analyses.

Results

Sixty-five patients (20 female) were identified with the diagnosis of Fournier’s gangrene. The mean age was 50.8 years. The most common etiology was hemorrhoidectomy in male and perianal abscess in female patients. The most commonly isolated microorganism in both male and female patients was Escherichia coli. Twenty-nine patients had diabetes mellitus, which was the most common predisposing factor. Mean hospitalization time was 24.4 days and the overall mortality was 27.70%.

Conclusion

Fournier’s gangrene is still an important disease with high mortality rates in spite of the developments in intensive care units and new-generation antibiotics. It seems that there are no major differences between male and female patients in the characteristics of the condition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Laucks SS 2nd. Fournier’s gangrene. Surg Clin North Am. 1994;74:1339–1352.

    PubMed  Google Scholar 

  2. Smith GL, Bunker CB, Dinneen MD. Fournier’s gangrene. Br J Urol. 1998;81:347–355.

    PubMed  CAS  Google Scholar 

  3. Sutherland ME, Meyer AA. Necrotizing soft-tissue infections. Surg Clin North Am. 1994;74:591–607.

    PubMed  CAS  Google Scholar 

  4. Vick R, Carson RR. Fournier’s disease. Urol Clin North Am. 1999;26:841–849.

    Article  PubMed  CAS  Google Scholar 

  5. Yaghan RJ, Al-Jaberi TM, Bani-Hani I. Fournier’s gangrene: changing face of the disease. Dis Colon Rectum. 2000;43:1300–1308.

    Article  PubMed  CAS  Google Scholar 

  6. Gaeta M, Volta S, Minutoli A, Bartiromo G, Pandolfo I. Fournier gangrene caused by a perforated retroperitoneal appendix: CT demonstration. AJR Am J Roentgenol. 1991;156:341–342.

    PubMed  CAS  Google Scholar 

  7. Hejase MJ, Simonin JE, Bihrle R, Coogan CL. Genital Fournier’s gangrene: experience with 38 patients. Urology. 1996;47:734–739.

    Article  PubMed  CAS  Google Scholar 

  8. Clayton MD, Fowler JE Jr., Sharifi R, Pearl RK. Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. Surg Gynecol Obstet. 1990;170:49–55.

    PubMed  CAS  Google Scholar 

  9. Paty R, Smith AD. Gangrene and Fournier’s gangrene. Urol Clin North Am. 1992;19:149–162.

    PubMed  CAS  Google Scholar 

  10. Ayan F, Sunamak O, Paksoy SM, et al. Fournier’s gangrene: a retrospective clinical study on forty-one patients. ANZ J Surg. 2005;75:1055–1058.

    Article  PubMed  Google Scholar 

  11. Kuo CF, Wang WS, Lee CM, Liu CP, Tseng HK. Fournier’s gangrene: ten-year experience in a medical center in northern Taiwan. J Microbiol Immunol Infect. 2007;40:500–506.

    PubMed  Google Scholar 

  12. Adams JR Jr., Mata JA, Venable DD, Culkin DJ, Bocchini JA Jr. Fournier’s gangrene in children. Urology. 1990;35:439–441.

    Article  PubMed  Google Scholar 

  13. Ayumba BR, Magoha GA. Epidemiological aspects of Fournier’s gangrene at Kenyatta National Hospital, Nairobi. East Afr Med J. 1998;75:586–589.

    CAS  Google Scholar 

  14. Brissiaud JC, Azam P, Paret B, Lopy J, Louis C, Collet F. Skin gangrene of the external genitalia. Report of 44 cases. Chirurgie. 1998;123:387–393.

    Article  PubMed  CAS  Google Scholar 

  15. Benchekroun A, Lachkar A, Bjijou Y, et al. Gangrene of the external genital organs. Apropos of 55 cases. J Urol (Paris). 1997;103:27–31.

    CAS  Google Scholar 

  16. Benizri E, Fabiani P, Migliori G, et al. Gangrene of the perineum. Urology. 1996;47:935–939.

    Article  PubMed  CAS  Google Scholar 

  17. Ghnnam WM. Fournier’s gangrene in Mansoura Egypt: a review of 74 cases. J Postgrad Med. 2008;54:106–109.

    Article  PubMed  CAS  Google Scholar 

  18. Carvalho JP, Hazan A, Cavalcanti AG, Favorito LA. Relation between the area affected by Fournier’s gangrene and the type of reconstructive surgery used. A study with 80 patients. Int Braz J Urol. 2007;33:510–514.

    Google Scholar 

  19. Unalp HR, Kamer E, Derici H, et al. Fournier’s gangrene: evaluation of 68 patients and analysis of prognostic variables. J Postgrad Med. 2008;54:102–105.

    PubMed  CAS  Google Scholar 

  20. Basoglu M, Ozbey I, Atamanalp SS, et al. Management of Fournier’s gangrene: review of 45 cases. Surg Today. 2007;37:558–563.

    Article  PubMed  Google Scholar 

  21. Ferreira PC, Reis JC, Amarante JM, et al. Fournier’s gangrene: a review of 43 reconstructive cases. Plast Reconstr Surg. 2007;119:175–184.

    Article  PubMed  CAS  Google Scholar 

  22. Kabay S, Yucel M, Yaylak F, et al. The clinical features of Fournier’s gangrene and the predictivity of the Fournier’s Gangrene Severity Index on the outcomes. Int Urol Nephrol. 2008;Jun 19. [E-pub ahead of print.]

  23. Ersay A, Yilmaz G, Akgun Y, Celik Y. Factors affecting mortality of Fournier’s gangrene: review of 70 patients. ANZ J Surg. 2007;77:43–48.

    Article  PubMed  Google Scholar 

  24. Yanar H, Taviloglu K, Ertekin C, et al. Fournier’s gangrene: risk factors and strategies for management. World J Surg. 2006:30:1750–1754.

    Article  PubMed  Google Scholar 

  25. Eke N. Fournier’s gangrene, still an enigma. J Postgrad Med. 2008;54:83–84.

    PubMed  CAS  Google Scholar 

  26. Eke N. Fournier’s gangrene: a review of 1726 cases. Br J Surg. 2000;87:718–728

    Article  PubMed  CAS  Google Scholar 

  27. Stephenson H, Dotters DJ, Katz V, Droegemueller W. Necrotizing fasciitis of the vulva. Am J Obstet Gynecol. 1992;166:1324–1327.

    PubMed  CAS  Google Scholar 

  28. Spirnak JP, Resnick MI, Hampel N, Persky L. Fournier’s gangrene: report of 20 patients. J Urol. 1984;131:289–291.

    PubMed  CAS  Google Scholar 

  29. Joo P, Peters WJ. Fournier’s gangrene. Can J Surg. 1985;28:180–182.

    PubMed  CAS  Google Scholar 

  30. Cunningham BL, Nivatvongs S, Shons AR. Fournier’s syndrome following anorectal examination and mucosal biopsy. Dis Colon Rectum. 1979;22:51–54.

    Article  PubMed  CAS  Google Scholar 

  31. Khan SA, Smith NL, Gonder M, Ravo B, Siddharth P. Gangrene of male external genitalia in a patient with colorectal disease. Anatomic pathways of spread. Dis Colon Rectum. 1985;28:519–522.

    Article  PubMed  CAS  Google Scholar 

  32. Flanigan RC, Kursh ED, McDougal WS, Persky L. Synergistic gangrene of the scrotum and penis secondary to colorectal disease. J Urol. 1978;119:369–371.

    PubMed  CAS  Google Scholar 

  33. Dewire DM, Bergstein JM. Carcinoma of the sigmoid colon: an unusual cause of Fournier’s gangrene. J Urol. 1992;147:711–712.

    PubMed  CAS  Google Scholar 

  34. Moreira CA, Wongpakdee S, Gennaro AR. A foreign body (chicken bone) in the rectum causing extensive perirectal and scrotal abscess: report of a case. Dis Colon Rectum. 1975;18:407–409.

    Article  PubMed  CAS  Google Scholar 

  35. Gutman H, Gonen P, Deutsch AA. Complications of anal dilatation for acute anal fissure. Dis Colon Rectum. 1989;32:545.

    Article  PubMed  CAS  Google Scholar 

  36. Clay LD 3rd, White JJ Jr., Davidson JT, Chandler JJ. Early recognition and successful management of pelvic cellulitis following hemorrhoidal banding. Dis Colon Rectum. 1986;29:579–581.

    Article  PubMed  Google Scholar 

  37. Lamb RC, Juler GL. Fournier’s gangrene of the scrotum. A poorly defined syndrome or a misnomer? Arch Surg. 1983;118:38–40.

    PubMed  CAS  Google Scholar 

  38. Roberts DB, Hester LL Jr. Progressive synergistic bacterial gangrene arising from abscesses of the vulva and Bartholin’s gland duct. Am J Obstet Gynecol. 1972;114:285–291.

    PubMed  CAS  Google Scholar 

  39. Stephens BJ, Lathrop JC, Rice WT, Gruenberg JC. Fournier’s gangrene: historic (1764–1978) versus contemporary (1979-1988) differences in etiology and clinical importance. Am Surg. 1993;59:149–154.

    PubMed  CAS  Google Scholar 

  40. Baskin LS, Carroll PR, Cattolica EV, McAninch JW. Necrotising soft tissue infections of the perineum and genitalia. Bacteriology, treatment and risk assessment. Br J Urol. 1990;65:524–529.

    PubMed  CAS  Google Scholar 

  41. Kattan S, Youssef A. Fournier’s gangrene of the scrotum following anorectal disorders. Int Urol Nephrol. 1994;26:215–222.

    Article  PubMed  CAS  Google Scholar 

  42. Jones RB, Hirschmann JV, Brown GS, Tremann JA. Fournier’s syndrome: necrotizing subcutaneous infection of the male genitalia. J Urol. 1979;122:279–282.

    PubMed  CAS  Google Scholar 

  43. Rudolph R, Soloway M, DePalma RG, Persky L. Fournier’s syndrome: synergistic gangrene of the scrotum. Am J Surg. 1975;129:591–596.

    Article  PubMed  CAS  Google Scholar 

  44. Laor E, Palmer LS, Tolia BM, Reid RE, Winter HI. Outcome prediction in patients with Fournier’s gangrene. J Urol. 1995;154:89–92.

    Article  PubMed  CAS  Google Scholar 

  45. Di Falco G, Guccione C, D’Annibale A, et al. Fournier’s gangrene following a perianal abscess. Dis Colon Rectum. 1986;29:582–585.

    Article  PubMed  Google Scholar 

  46. Moorthy K, Rao PP, Supe AN. Necrotising perineal infection: a fatal outcome of ischiorectal fossa abscesses. J R Coll Surg Edinb. 2000;45:281–284.

    PubMed  CAS  Google Scholar 

  47. Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcin O. Fournier’s gangrene: report of thirty-three cases and a review of the literature. Int J Urol. 2006;1:960–967.

    Article  Google Scholar 

  48. Diettrich NA, Mason JH. Fournier’s gangrene: a general surgery problem. World J Surg. 1983;7:288–294.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Selçuk M. Hazinedaroğlu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Çakmak, A., Genç, V., Akyol, C. et al. Fournier’s gangrene: Is it scrotal gangrene?. Adv Therapy 25, 1065–1074 (2008). https://doi.org/10.1007/s12325-008-0103-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-008-0103-1

Keywords

Navigation