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Y3M - Urology > Fournier's Gangrene > Flashcards

Flashcards in Fournier's Gangrene Deck (11)
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1

What is FG?

A form of necrotising fasciitis that affects the perineum.

It is a urological emergency with mortality rate of 20-40%.

2

Classification

Monomicrobial or polymicrobial

3

Causative organisms

Group A streptococcus

C. Perfringes

E. coli

4

Spread of FG

Based on scrotal anatomy

Anatomic barriers include the dartos fascia of the penis and scrotum.

Colles fascia of the perineum

Scarpa fascia of the anterior abdominal wall.

This all means that the testes and epididymis are commonly not affected.

5

Risk factors

DM

Excess alcohol

Poor nutritional status

Steroid use

Haematoligcal malignancies

Recent trauma to the region

6

Clinical features

Severe pain out of proportion to clinical signs

Pyrexia

Usually non-specific and it usually looks "not quite right" for simple cellulitis

Crepitus, skin necrosis and haemorrhagic bullae might present as the condition progresses.

Sensory loss of overlying skin

Patients rapidly deteriorate and become significantly unwell.

Sepsis and septic shock to follow

7

Dx

Cellulitis

Epididiymo orchitis

Testicular torsion

8

Investigations

Diagnosis is largely clinical and should be taken for immediate surgical exploration

Routine bloods with blood cultures should be taken

CT might be done which can show fascial swelling and soft tissue gas, but it should not delay surgical exploration

9

Risk scoring for necrotising fasciitis

Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC)

10

Explain LRINEC

Based on laboratory factors a score of 6 or more is a reasonable score to consider the diagnosis on lab results alone.

11

Management

Urgent surgical debridement

Partial or total orchiectomy as well depending of the size of expansion.

Broad-spectrum abx + transfer to high-dependency setting

Fluid resus and close monitoring

Further surgical debridement is commonly required.

Secondary close with skin grafts can be a long process with variable outomces.