Abstract
Background
Fournier gangrene (FG) is a rare, life-threatening infection that can result in significant
morbidity and mortality, with many patients requiring emergency department (ED) management
for complications and stabilization.
Objective
This narrative review provides an evidence-based summary of the current data for the
emergency medicine evaluation and management of FG.
Discussion
Although originally thought to be an idiopathic process, FG has been shown to have
a strong association for male patients with advanced age and comorbidities affecting
microvascular circulation and immune system function, most commonly those with diabetes
or alcohol use disorder. However, it can also affect patients without risk factors.
The initial infectious nidus is usually located in the genitourinary tract, gastrointestinal
tract, or perineum. FG is a mixed infection of aerobic and anaerobic bacterial flora.
The development and progression of gangrene is often fulminant and can rapidly cause
multiple organ failure and death, although patients may present subacutely with findings
similar to cellulitis. Laboratory studies, as well as imaging including point-of-care
ultrasound, conventional radiography, and computed tomography are important diagnostic
adjuncts, though negative results cannot exclude diagnosis. Treatment includes emergent
surgical debridement of all necrotic tissue, broad-spectrum antibiotics, and resuscitation
with intravenous fluids and vasoactive medications.
Conclusions
FG requires a high clinical level of suspicion, combined with knowledge of anatomy,
risk factors, and etiology for an accurate diagnosis. Although FG remains a clinical
diagnosis, relevant laboratory and radiography investigations can serve as useful
adjuncts to expedite surgical management, hemodynamic resuscitation, and antibiotic
administration.
Keywords
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Article info
Publication history
Published online: August 28, 2019
Accepted:
June 15,
2019
Received in revised form:
June 12,
2019
Received:
February 1,
2019
Footnotes
This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program.
Identification
Copyright
Published by Elsevier Inc.
