Penis and scrotum
Infectious disorders
Fournier gangrene

Authors: Antonio Cubilla, M.D., Alcides Chaux, M.D. (see Authors page)

Revised: 28 March 2018, last major update May 2010

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Fournier gangrene penis

Cite this page: Cubilla, A., Chaux, A. Fournier gangrene. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/penscrotumfournier.html. Accessed October 20th, 2018.
Definition / general
Epidemiology
  • Elderly adults (male and female), immunocompromised (particularly diabetes) or those with depressed mental status
Sites
  • Dartos and penile fascia are preferred sites
Etiology
  • 50 - 60% of infections have GI or GU source of infection
  • Usually a polymicrobial infection
  • Streptococcus and Staphylococcus most common in children
  • Gram negative bacilli and anaerobic bacteria most common in adults
  • Source of infection may be colorectal, urologic or cutaneous
  • Infection spreads from skin down fascial plane, causing inflammation, ischemia and necrosis; low oxygen tension and necrosis promote anaerobes and cause rapid dissemination
  • Obliterative endarteritis plays a key role in pathogenesis
Diagrams / tables

Images hosted on other servers:

Fournier gangrene severity index

Clinical features
  • Patients present with genital induration, pain, erythema and crepitus
  • Xrays may show air in perineal tissue
  • To diagnose, MUST examine genitals, particularly in elderly or patients with diminished mental status
  • Finding nidus of infection is important - may be periurethral or perirectal
  • History of perineal trauma is important
  • Affects Buck fascia and foreskin, sparing glans
  • Mortality rate of 7 - 22%, even with timely and aggressive therapy (J Urol 2009;181:2120)
Prognostic factors
  • Fournier gangrene severity index (FGSI) scores > 9 predicts severity and mortality (J Urol 1995;154:89, J Postgrad Med 2008;54:102)
  • FGSI: nine variables are assigned scores of 0 - 4, which are added together
  • Variables are body temperature, heart rate, respiratory rate, serum sodium, serum potassium, serum creatinine, hematocrit and white blood count and serum bicarbonate (see table above)
  • Cirrhosis, not a FGSI factor, is also a poor prognostic factor (J Microbiol Immunol Infect 2007;40:500)
Case reports
Treatment
  • Aggressive medical treatment (fluids, broad spectrum antibiotics) plus aggressive surgical debridement with aggressive wound care
  • Skin grafts are usually not required due to elasticity of genital skin (West J Emerg Med 2009;10:281)
  • Hyperbaric oxygen does not appear to be useful
Clinical images

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Necrosis spreading along fascial planes

Paraphimosis

Lesions on penis and scrotum

Gross images

Images hosted on PathOut server:

Extensive sloughing

Corbus disease: necrosis of glans

Corbus disease: cut surface

Microscopic (histologic) description
  • Penile fascia with severe inflammation (neutrophils), bacteria and necrotic tissue
  • Thrombosis of small vessels (obliterative endarteritis)
  • Deep erectile tissue usually remains unaffected
Microscopic (histologic) images

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Bacteria, neutrophils and necrotic tissue

Differential diagnosis