Introduction:
The human body consists of billions of cells and tissues that are designed to carry out their specific functions. These tissues receive blood supply from various blood vessels to carry out their activities. However, the problem arises when these tissues lack blood supply. It can be due to bacterial infection or other conditions that damage the blood vessels. When the tissues do not receive their blood supply, they die, and this condition is known as gangrene.
The risk of gangrene increases when the person suffers from diabetes and conditions that affect blood flow, like atherosclerosis. Gangrene mainly affects the toes, fingers, arms, legs, and internal organs of the body, like the gallbladder. The condition is known as Fournier gangrene when gangrene affects organs like the penis, scrotum, and perineum. It is a medical emergency and needs to be treated at the earliest.
What Is Fournier Gangrene?
Fournier gangrene is a life-threatening disorder that rarely occurs in organs like the penis, scrotum, and perineum (the area between the scrotum and the anus). It is a type of necrotizing fasciitis that spreads rapidly. Necrotizing fasciitis is a condition in which the infection spreads rapidly to the soft tissues, muscles, nerves, and blood vessels, resulting in death. The organs responsible for the reproductive function appear swollen and red. If the condition is left untreated for a long time, the infection spreads rapidly to the body's other tissues, including the thigh, chest, and stomach. Fournier gangrene can result in the death of the person. However, there are treatment options available for the condition, but the patient requires immediate medical care and attention.
What Are the Causes of Fournier Gangrene?
Fournier gangrene is commonly seen in males and has been named after the French physician who discovered it. Fournier gangrene is mainly caused when bacteria enter the genitals through various sources. The bacteria responsible for causing Fournier gangrene are listed below:
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Escherichia coli (E.coli).
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Proteus.
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Staphylococcus.
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Streptococcus.
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Bacteroides.
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Clostridium.
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Peptostreptococcus.
The bacteria gains entry into the human body through the following ways:
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Abscess or swelling.
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Genital piercing.
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Urinary tract infection or bladder infection.
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Insect bites.
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Rectal or anal cancer.
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Anal fistula.
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Burn injuries.
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Ulcer.
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Intercourse.
How Do Bacteria Damage the Body in Fournier Gangrene?
The skin is the first line of defense against any bacterial infection. However, the problem occurs when abscesses, ulcers, insect bites, and burn injuries cause a break in the continuity of the skin. As a result, the bacteria enter the body and multiply rapidly to infect the organs. The mechanism by which the bacteria damage the body in Fournier gangrene is described below.
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First, the bacteria enter the penis, scrotum, and perineal region and damage the muscle fascia and the surrounding tissues.
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Fascia is a thin layer of connective tissue that covers the body's blood vessels, muscles, nerves, bones, and organs. The skin comprises a layer of connective tissues and fat cells known as subcutaneous tissue.
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Certain blood vessels are also present in the muscle fascia and the subcutaneous tissue. These blood vessels supply nutrients and oxygen to the body tissues. Also, an artery known as the pudendal artery supplies blood to the scrotum and the sex organs.
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When the bacteria enter the subcutaneous tissues, they destroy the pudendal artery. As a result, the blood supply to the penis, scrotum, and other sex organs is lost, resulting in the death of the tissues.
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The bacteria move further and damage the muscles, skin, and arteries of the penis, perineum, and scrotum.
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Finally, the bacteria spread to the chest, thigh, and stomach and damaged them. At this point, the patient starts experiencing the symptoms. By the time the patient notices the condition, the bacteria have already damaged the major blood vessels of the genital tract.
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Fournier gangrene is a dangerous condition. Every hour is a battle of life and death, and the patient needs intensive care and protection.
What Are the Risk Factors for Fournier Gangrene?
Fournier gangrene is a severe condition in which the organs of the urogenital tract, like the penis and scrotum, get damaged due to bacterial infection. The factors that increase the risk of Fournier gangrene are listed below:
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Diabetes - Diabetes is a condition in which the blood sugar levels are high due to insulin resistance or lack of insulin. High blood glucose levels damage the blood vessels of the body. As a result, the organs like the penis and scrotum fail to receive a good blood supply, increasing the risk of Fournier gangrene.
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Smoking - Smokers are more likely to develop Fournier gangrene than non-smokers. Smoking blocks the arteries, resulting in the loss of blood supply to the body's organs.
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Atherosclerosis - Atherosclerosis is a condition in which the blood vessels become narrow due to the deposition of fats. As a result, the tissues do not receive a proper blood supply, and they die.
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Obesity - Obesity or excessive weight puts pressure on the arteries, increasing gangrene risk. When the arteries get compressed, they cannot supply blood to the body tissues.
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Hypertension - Hypertension or high blood pressure increases the risk of gangrene because the blood vessels get damaged when the blood flows under high pressure.
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Immunocompromised Disorders - Patients suffering from immunocompromised disorders like Human immunodeficiency virus (HIV) are more likely to suffer from Fournier gangrene. It is because these patients have weak immune systems and cannot fight bacteria.
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Cirrhosis - Cirrhosis is a condition in which healthy liver tissues are damaged and replaced by scar tissues. Cirrhosis slows down the blood flow and increases the risk of tissue necrosis and gangrene.
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Aging - People above 50 are at a high risk of gangrene because they suffer from other disorders like diabetes and atherosclerosis that damage the blood supply to the tissues.
What Are the Signs and Symptoms of Fournier Gangrene?
The symptoms of Fournier gangrene can be divided into early symptoms and late symptoms. The symptoms that are noticed first are listed below:
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Swelling of the genitals and the perineum.
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Pain in the genitals and perineum.
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Redness of the perineal region.
The symptoms that are seen at a later stage are listed below:
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The altered mental state of the patient.
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Fever.
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Dehydration.
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Inflammation.
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Fatigue.
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Nausea and vomiting.
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Moderate to severe abdominal pain.
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Foul smell.
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Hypotension, or low blood pressure.
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Tachycardia, or increased heart rate.
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A crackling sound is heard when the patient rubs the infected area (crepitus).
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Restricted flow of urine due to urethral obstruction.
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Urine accumulates in the body cavities rather than the bladder.
What Tests Are Done to Diagnose Fournier Gangrene?
The diagnosis of Fournier gangrene is based on medical history, blood tests, physical examination, and imaging tests. The diagnostic methods are listed below:
1. Medical History - The medical history gives an idea about the patient's general health. The doctor might ask questions related to the symptoms, the time of their onset and progression, drug history, recent injury, and if the patient has undergone any surgery in the past.
2. Physical Examination - The doctor checks the physical signs of Fournier gangrene, like tenderness and swelling in the genitals, skin itching, and inflammation. The heart rate and blood pressure of the patient are also checked because patients who are suffering from Fournier gangrene often present with tachycardia and hypotension.
3. Comprehensive Metabolic Panel - It is a type of blood test that helps the doctor check the levels of white blood cells, electrolytes, glucose, blood gases, creatinine, and proteins in the blood.
4. Imaging Tests - The following imaging tests are usually recommended:
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Ultrasound - It is a type of imaging test in which the sound waves are sent to the body organs with the help of a device known as a transducer. The advantage of this procedure is that the person is not exposed to X-ray radiation, so it can be carried out in females and children. The doctor moves the transducer at different angles to obtain images of the internal organs. These images help to check whether the disease is Fournier gangrene or a similar disorder like epididymitis or orchitis.
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Computed Tomography (CT) Scan - In this procedure, the patient is laid on a table, and a liquid (contrast medium) is injected into his body. The table slides into a tunnel-like device where the images are obtained. It provides three-dimensional (3D) images of the internal organs and helps to check the gasses and fluids present in the body. It also helps the doctor to identify the source of the infection.
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X-rays - X-rays of the body organs help to detect the presence of a tumor, stones, and other diseases that cause infections. It also helps to check the distance up to which the air has spread into the soft tissues.
How to Manage Fournier Gangrene?
Treatment of Fournier gangrene is done with the help of antibiotics and surgery. The treatment options have been described below:
1. Antibiotics - Multiple bacteria are responsible for causing Fournier gangrene. So, the antibiotics must be strong enough to attack and kill all these bacteria. Such antibiotics are known as broad-spectrum antibiotics, as they kill different types of bacteria at the same time. The following drugs are usually recommended:
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Clindamycin.
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Vancomycin.
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A combination of Ampicillin and Sulbactam.
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Ciprofloxacin.
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A combination of Piperacillin and Tazobactam.
2. Debridement - Surgical debridement is a procedure in which the dead and infected tissues of the affected area are removed. The affected skin is opened to expose the damaged tissues and the fascia. All the tissues contaminated due to bacterial infection are removed carefully. During the debridement procedure, only the infected tissues are removed and not the organs like the penis or testes.
3. Reconstructive Surgery - After the surgical debridement procedure, the doctor checks the area to ensure the healthy tissues have formed; next, reconstructive surgery is performed wherein the healthy skin is taken from other body areas and placed on the affected side. The surgery aims to restore the normal appearance of the organs affected by gangrene.
4. Hyperbaric Oxygen Therapy - As the name suggests, hyperbaric oxygen therapy aims to provide extra oxygen to the patient to allow wound healing. This therapy is carried out in a pressurized chamber that consists of oxygen. The patient is laid on a table that slides into a plastic tube. The pressure inside the tube slowly rises, exposing the patient to an oxygen-rich environment. When the patient breathes in the chamber, the oxygen enters the body and combines with the blood. This oxygenated blood flows to different organs of the body and slows down bacterial growth.
How to Prevent Fournier Gangrene?
There are no home remedies available to cure Fournier gangrene. However, the following steps help to reduce the risk of gangrene:
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The patient must keep his genitals clean to prevent bacterial accumulation.
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Use a clean razor while shaving to prevent injury and contamination.
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Diabetics must check their genitals and other areas for injury, swelling, or infection. It is because they are at a higher risk of developing Fournier gangrene.
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Maintain a healthy body weight and exercise regularly to stay fit.
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If the patient has a habit of smoking, chewing tobacco, and drinking alcohol, he must immediately quit these habits.
Conclusion:
Fournier gangrene is a condition in which bacteria accumulate in the genitals, mainly the penis, scrotum, and perineal region. The blood supply is lost due to bacterial accumulation, and the tissues present in these areas die. It is a life-threatening condition that cannot be cured at home, and the patient must be rushed to the hospital immediately. The treatment depends on how early the patient notices the symptoms. Antibiotics are enough to cure the disease if the patient consults the doctor on time. However, the patient must undergo surgical debridement and reconstructive surgery in later stages. The disease can also be prevented in several ways, like maintaining a healthy body weight and practicing good hygiene. Consult the doctor to know more about Fournier gangrene and its treatment options.
