• Registration
  • Login
JETem
  • Home
  • About
    • Aim and Scope
    • Our Team
    • Editorial Board
    • FAQ
  • Issues
    • Current Issue
    • Ahead of Print
    • Past Issues
  • Visual EM
    • Latest Visual EM
    • Search Visual EM
    • Thumbnail Library
  • For Authors
    • Instructions for Authors
    • Submit to JETem
    • Photo Consent
    • Policies
      • Peer Review Policy
      • Copyright Policy
      • Editorial Policy, Ethics and Responsibilities
      • Conflicts of Interest & Informed Consent
      • Open Access Policy
  • For Reviewers
    • Instructions for JETem Reviewers
    • Interested in Being a JETem Reviewer?
  • Topic
    • Abdominal / Gastroenterology
    • Administration
    • Board Review
    • Cardiology / Vascular
    • Clinical Informatics, Telehealth and Technology
    • Dermatology
    • EMS
    • Endocrine
    • ENT
    • Faculty Development
    • Genitourinary
    • Geriatrics
    • Hematology / Oncology
    • Infectious Disease
    • Miscellaneous
    • Neurology
    • Ob / Gyn
    • Ophthalmology
    • Orthopedics
    • Pediatrics
    • Procedures
    • Psychiatry
    • Renal / Electrolytes
    • Respiratory
    • Toxicology
    • Trauma
    • Ultrasound
    • Wellness
    • Wilderness
  • Modality
    • Curricula
    • Innovations
    • Lectures
    • Oral Boards
    • Podcasts
    • Simulation
    • Small Group Learning
    • Team Based Learning
    • Visual EM
  • Contact Us

Fournier Gangrene

Joseph Zakaria, BS*, Steve Bunch, MD* and Victor Cisneros, MD, MPH*

*University of California, Irvine, Department of Emergency Medicine, Orange, CA

Correspondence should be addressed to Joseph Zakaria, BS at Jnzakari@uci.edu 

DOI: https://doi.org/10.21980/J89626Issue 3:4
Infectious DiseaseVisual EM
No ratings yet.

History of present illness:

A 35-year-old male with a history of diabetes mellitus presented to the emergency department in septic shock with hypotension, tachycardia, and labs notable for leukocytosis, glucose of 357, and lactate of 3. The patient was complaining of a draining right buttock abscess for five days, with perineal and scrotum pain and swelling for the past two days.

Significant findings:

The computed tomography (CT) of the abdomen and pelvis revealed significant subcutaneous gas tracking along the perineum and right gluteal region (orange outline) into the scrotum with associated scrotal edema (yellow arrow) and subcutaneous inflammatory fat stranding of 0.92 cm (red arrow) consistent with Fournier’s gangrene.  There is early fluid loculation along the right medial gluteal cleft of 5.85 cm (green arrow) without a sizeable drainable abscess seen.

Discussion:

Fournier gangrene is typically seen in diabetic men aged 50-70. Other factors that predispose to Fournier’s is immunosuppression and alcoholism.1 The most common organisms isolated are Proteus, Klebsiella, Streptococcus,Staphylococcus, and E. coli.1 As seen in our patient, the most common source of spread is via perianal infections which are seen in 19%-50% of patients.2 Fournier gangrene can be life-threatening with a mortality rate ranging between 15%-50%.3 The classic exam finding of crepitus is only seen in 19%-64% of cases.4 Thus, while the diagnosis is often made clinically, further diagnosis with CT is preferred because it can show the source of infection and path of spread.5 CT is the modality of choice over ultrasound because it can detect fluid collections in the deep fascial planes, whereas direct pressure on the perineum with ultrasound is often not tolerated and cannot detect the small pockets of gas in tissues that CT does in patients with Fournier gangrene.5

Fournier gangrene patients must undergo surgical debridement, and adequate debridement positively impacts outcomes.6 This patient was diagnosed with Fournier’s gangrene and admitted to the emergency general surgery service for emergent debridement of the perianal and gluteal abscess.

Topics:

Fournier gangrene, CT, perianal abscess.

References:

  1. Uppot RN, Levy HM, Patel PH. Case 54: Fournier gangrene. Radiology. 2003;226(1):115-117. doi: 10.1148/radiol.2261010714
  2. Morpurgo E, Galandiuk S. Fournier’s gangrene. Surg Clin North Am.2002;82(6):1213-1224. doi: 10.1016/S0039-6109(02)00058-0
  3. Levenson RB, Singh AK, Novelline RA. Fournier gangrene: role of imaging. Radiographics. 2008;28(2):519-528. doi: 10.1148/rg.282075048
  4. Kube E, Stawicki S, Bahner D. Ultrasound in the diagnosis of Fournier’s gangrene. Int J Crit Ill Inj Sci. 2012;2(2):104-106. doi: 10.4103/2229-5151.97276
  5. Avery LL, Scheinfeld MH. Imaging of penile and scrotal emergencies. Radiographics. 2013;33(3):721-740. doi: 10.1148/rg.333125158
  6. Vick R, Carson CC 3rd. Fournier’s disease. Urol Clin North Am.1999;(26):841-849. doi: 10.1016/s0094-0143(05)70224-X
Icon

Fournier gangrene - Case Report

1 file(s) 338 KB
Download
Icon

Fournier gangrene - Images

1 file(s) 48 MB
Download
CTIssue 3:4

Reviews:

No ratings yet.

Please rate this





Foreign Body in Maxillary Sinus: A Rare Case of...

28 Sep, 18

Facial Fracture Induced Periorbital Emphysema

28 Sep, 18
JETem is an online, open access, peer-reviewed journal-repository for EM educators

Most Viewed

  • Telemedicine Consult for Shortness of Breath Due to Sympathetic Crashing Acute Pulmonary Edema
  • Anticholinergic Toxicity in the Emergency Department
  • The Suicidal Patient in the Emergency Department Team-Based Learning Activity
  • Child Maltreatment Education: Utilizing an Escape Room Activity to Engage Learners on a Sensitive Topic
  • Acute Chest Syndrome

Visit Our Collaborators

About

Education

Learners should benefit from active learning. JETem accepts submissions of team-based learning, small group learning, simulation, podcasts, lectures, innovations, curricula, question sets, and visualEM.

Scholarship

We believe educators should advance through the scholarship of their educational work. JETem gives educators the opportunity to publish scholarly academic work so that it may be widely distributed, thereby increasing the significance of their results.

Links

  • Home
  • Aim and Scope
  • Current Issue
  • For Reviewers
  • Instructions for Authors
  • Contact Us

Newsletter

Sign up to receive updates from JETem regarding newly published issues and findings.

Copyright © 2016 JETem. All rights reserved.