Fournier's Gangrene Diagnosis and Treatment: A Systematic Review.

Gregory D Lewis,Nelson Davis,Arjun Patel,Catherine A Olang,Maliha Majeed,Vasavi Rakesh Gorantla,Sarah Gluschitz

doi:10.7759/cureus.18948

Abstract

Fournier’s gangrene (FG) is a perineal and abdominal necrotizing infection. It is most commonly found in middle-aged men with comorbidities such as diabetes mellitus. Initial symptoms are often indistinct and can rapidly progress to overwhelming infections with a relatively high mortality rate. It is crucial to make a prompt diagnosis so that the patient receives appropriate treatment. Given the importance of the identification of FG, we explored what were the most common signs and symptoms associated with FG, as well as distinguished the gold standard treatment. This systematic review utilized articles identified exclusively through PubMed using key terms such as Fournier’s gangrene, signs, symptoms, and treatment. A total of 37 studies, including a total of 3,224 patients (3,093 males and 131 females), fit our inclusion parameters for relevance that included either the most identifiable presentation of FG or the most effective treatment. From our search, the most common clinical presentation was scrotal and labial pain, fever, abscesses, crepitus, erythema, and cellulitis. Diagnosis is made from clinical findings in conjunction with imaging. The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. The importance of early identification for improved outcomes or survival highlights the need for further studies or measures to enhance the identification of the signs and symptoms of FG.

Highlights

BackgroundIn the United States, Fournier’s gangrene (FG) is a rare and fatal form of necrotizing fasciitis, with an incidence rate of approximately 1.6 per 100,000 males [1]
After screening and assessment of the results based on inclusion criteria and study objectives, 37 articles were included for the presentation, symptoms, or treatment of FG [2,5,6,7,10,11,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42]
The review indicated that the main symptoms were scrotal and labial pain, fever, abscesses, crepitus, erythema, and cellulitis

Summary

Introduction

BackgroundIn the United States, Fournier’s gangrene (FG) is a rare and fatal form of necrotizing fasciitis, with an incidence rate of approximately 1.6 per 100,000 males [1]. FG is a rapidly spreading infection that spreads through the superficial and deep fascial layers in the perineal, genital, or perianal regions, causing multiple organ failure and septic shock. FG is considered to be a polymicrobial infection caused by multiple organisms, including aerobic and anaerobic species such as Escherichia coli and Bacteroides fragilis. These microbes collaborate to release enzymes that cause tissue necrosis [6]. The bacterial organisms that cause this necrotic infection release collagenases, which cause rapid tissue destruction at a rate of one inch per hour [3], allowing the infection to quickly spread from the genital region to the anterior abdominal wall and vital organs [7]

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