Fournier's Gangrene - Graphic content alert!

The following images are not apt for sensitive people.

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Hello steemians! As I already mentioned in my introduyourcelf, I am a medical student, currently on the 4th year of the career, so I am already in the stage of hospital internships, a few weeks ago I was on-duty on the general surgery service, when a gentleman of 50 years of age showed up, with this:

I will explain in a simple way, what he presented is a type of gangrene (death or necrosis of the tissue) called Fournier's Gangrene, which is the product of a bacterial infection in the genital region, medically speaking it is described as a necrotizing fasciitis of the genital and perianal region, usually secondary to anal and genitourinary infectious processes. It is a rare disease that can occur in both sexes (though mainly in men), at any age (it is most between 50 and 70 years of age), is potentially fatal as it evolves, and it is not incurable.

It is most commonly caused by a bacterium called Escherichia coli, but it can also be caused by Streptococcus, Staphylococcus aureus, Klesiella sp., Enterococci, Pseudomonas or a combination of them. We can usually find these bacteria in our body as part of the normal bacterial flora, living in harmony with our skin, which is a barrier that protects us against environmental aggressions such as batteries or chemicals.

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The infection can occur for multiple reasons: medical procedures (such as a vasectomy), ulcers, trauma, placement of piercings in the genitals, or any injury where the corresponding techniques of asepsis and antisepsis were not properly applied to prevent the arrival of microorganisms through of the skin (that is why it is fundamental to have good hygiene). The disease has a rapid evolution, it initially manifests as fever, in the infected area there is swelling (edema, caused by a retention of liquid) and redness (erythema) of the skin and soft tissues, after a day or more of initiating the symptoms, pain appears, and there is hypersensitivity in the infected area and a feeling of general malaise, then the tissue begins to necrotize. Once the gangrene is established it extends about 2-3 cm / hour.

The diagnosis is fundamentally clinical; patients generally enter when the necrotic lesion is already present. Once you see a Fournier’s gangrene for the first time, it is almost impossible to forget, so the diagnosis can be established from the beginning, the complementary laboratory tests and imaging are only useful to confirm the infection, the real extent of the gangrene, and evaluate the response to the treatment.

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The treatment is multidisciplinary and urgent, combining medical treatment to fight the infection (administration of broad spectrum antibiotics such as Amoxicillin, Penicillin, Clindamycin, Cephalosporin and Metronidazole intravenously), life support maintenance (electrolyte and nutritional management by administering solutions intravenously) and surgical procedures. Surgical treatment consists in the debridement (removal) of the necrotic tissue to reach healthy tissue and thus be able to control the progression of the infection, then cover the exposed tissue with compresses (gauze) soaked with Betadine, which is an antiseptic that inhibits the proliferation (reproduction or multiplication) of microorganisms in the tissue. Every day, cures must be made to clean the exposed tissue, remove dead tissue and change the gauze until the gangrene no longer progresses, the infection is eliminated and the regeneration and healing process of the tissue is completed

^{The patient after tissue debridement.}

The prognosis depends on the delay of the surgical intervention and antibiotic treatment, the percentage of mortality can vary between 3% and up to 50%, so a diagnosis and early or immediate treatment is essential.

Speaking a bit about the case that was presented to us, the patient reports that the infection was caused by washing the perianal region (skin around the anus and rectum), with seemingly contaminated water in the food processing company where he works, a possible injury in the area explains the infiltration of the bacteria through the skin, as I mentioned, most patients come with an already evolving infection, so at the time of arrival the appearance and smell were quite unpleasant, the infection spread to the scrotum (skin that surrounds the testicles) and the penis, so he had dysuria (difficulty or pain to urinate) and obstruction of the urination. It was necessary to insert a Foley catheter in order to drain the urine, introduced into the bladder through a small hole in the abdomen. After the surgical debridement he was admitted (hospitalized) for proper care, today he continues in the hospital in which his surgical and medical treatment has evolved satisfactorily.

^{Remarkable improvement of the tissue.}

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References:

• Knowledge acquired during my career.
• Morpurgo E, Galandiuk S. Fournier’s gangrene. Surg Clin North Am 2002; 82: 1213-24
• Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier's Gangrene: Experience with 25 patients and use of Fournier's Gangrene severity index score. Urology, 64 (2004), pp. 218-22
• Laor E, Palmer LS, Tolia BM, Reid RE and Winter HI: Outcome prediction in patients with Fournier’s gangrene. J Urol 1995; 154: 89.
• Gurdal M, Yucenas E, Tekin A, Beysel M, Aslan R, Sengor F. Predisposing factors and treatment outcome in Fournier's gangrene. Analysis of 28 cases. Urol Int, 70 (2003), pp. 286-90
• Thomas Santora, MD, Fournier Gangrene, Emedicine. Updated: Mar 19, 2009.

Images of my authorship.

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I hope you have found this article interesting, I leave a special mention to @mike961 and his posts on Hydroelectrolytic disorders and Schizophrenia and its Effects.

Thanks to @steemstem and @air-clinic for their constant support to all scientific content.