What causes Fournier’s gangrene? – Medical News
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What causes Fournier’s gangrene?

Fournier’s gangrene is a sometimes life-threatening form of necrotizing fasciitis that affects the genital, perineal, or perianal regions of the body.

Necrotizing fasciitis is a serious condition that kills soft tissues, often quickly, including muscles, nerves, and blood vessels.

Fournier’s gangrene is rare but is a medical emergency when it does occur.

Fast facts on Fournier’s gangrene:

  • It most commonly affects men, particularly in the scrotum or penis.
  • Often, a variety of organisms will grow and infect the tissue.
  • If severe, a doctor may have to remove tissue, such as all or part of the penis or testicles.

What are the causes?

Alcoholic woman with a glass of whiskey in front of her.
A history of alcohol abuse, diabetes, or obesity may increase the risk of Fournier’s gangrene.

Fournier’s gangrene can occur when a person has a skin wound that allows bacteria, viruses, or fungi to get deeper into the body.

Examples of these skin injuries include anorectal abscesses, surgical incisions, diverticulitis, rectal cancer, or genital piercings.

In some individuals, the cause of Fournier’s gangrene is unknown. However, doctors have identified some risk factors that may make a person more likely to have Fournier’s gangrene.

These include:

  • diabetes
  • a history of alcohol abuse
  • a compromised immune system, such as in HIV
  • morbid obesity

According to an article in the journal ISRN Surgery, an estimated 20 to 70 percent of those with Fournier’s gangrene have diabetes. An estimated 25 to 50 percent have an alcohol abuse disorder.


Symptoms

The symptoms of Fournier’s gangrene often begin with a general feeling of being unwell. Symptoms can include:

  • malaise
  • moderate pain in the genital area
  • swelling in the genital area

These symptoms will continue to worsen. The pain associated with the condition becomes more severe. The tissues may also start to smell foul, which is the result of dying or rotting tissue.

Rubbing the affected areas of skin yields a distinct sound that is similar to a popping or crackling noise and is known as crepitus. This sound is due to the friction of gas and tissues moving against each other.

The presence of Fournier’s gangrene can set off a cascade of symptoms that can ultimately be deadly. These include:

  • Severe infection that spreads to the deeper tissues: This causes inflammation of the blood vessel linings called obliterative endarteritis.
  • The inflammation causes small blood clots to develop: The tissues lose their blood supply and begin to die.
  • The death of tissue releases bacteria and necrotic tissue byproducts into the bloodstream: These cause an inflammatory response in the body that leads to septic shock where the body cannot maintain blood pressure and organs begin to shut down. Septic shock can lead to death.

Seeking quick treatment can reduce the chances of symptoms becoming even more severe.

What are the treatment options?

surgical debridement being performed in operating room.
Surgical debridement may be performed to remove dead tissue and clean the skin.

Treatments associated with Fournier’s gangrene involve immediately starting a person on strong intravenous (IV) antibiotics in an attempt to kill off the infection.

Also, a doctor will perform a procedure known as surgical debridement. This involves cleaning the affected skin and removing areas of dead tissue.

Ideally, a doctor can remove enough tissue to keep the infection from spreading.

Sometimes, a person will have to go back to the operating room multiple times for surgical debridements.

According to an article in Postgraduate Medical Journal, a person with Fournier’s gangrene typically requires 3.5 procedures in an attempt to reduce the disease’s spread.

Oxygen therapy

Sometimes a doctor will recommend hyperbaric oxygen therapy. This involves exposing the body to 100 percent oxygen, in comparison to normal air that has about 21 percent oxygen.

The extra oxygen helps to keep bacteria from growing, reduces blood vessel damage, and promotes wound healing.

However, hyperbaric therapy is a controversial treatment for the condition because there are not any clinical trials that support its use.

Surgery

Surgery is sometimes the only other option. Ideally, a person will seek treatment fast enough to avoid having to remove an excess of skin and tissues.

Sometimes, skin grafting or other plastic surgery is needed to reconstruct and re-create damaged tissues.


Diagnosis

Doctor and patient consulting.
A diagnosis of Fournier’s gangrene may be made after taking a medical history and assessing symptoms.

Doctors will diagnose Fournier’s gangrene by first asking a person about their symptoms. They will take a medical history and perform a physical examination.

Imaging studies may be ordered to rule out other potential causes. For example, a doctor may ask for an ultrasound to determine if the condition is the result of inflammation or Fournier’s gangrene.

Other conditions that can initially appear similar to Fournier’s gangrene include epididymitis and orchitis.

Ultrasound can help a doctor identify underlying gases or fluids in the body. Computer tomography (CT) and X-rays may also help a doctor recognise Fournier’s gangrene.

Blood work to test for the possible presence of infection will be done, as well as to check for the blood’s clotting abilities.


Outlook

Hospital admissions for Fournier’s gangrene are rare, representing less than 0.02 percent of all hospital admissions in the United States.

Nevertheless, an estimated 20 to 40 percent of people with Fournier’s gangrene die due to complications, according to an article published in the journal Urologia Internationalis. Some studies report the mortality rates to be much higher.

As a general rule, the older a person is and the more complicating health conditions they have, the more likely they are to experience severe side effects from Fournier’s gangrene.

Seeking help without hesitation, as early as possible, can help keep the infection from spreading.

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