FOURNIER GANGRENE

From Big Medical Encyclopedia

FURNYo GANGRENE (J. A. Fournier, fr. dermatologist, 1832 — 1914; synonym: fulminant gas

gangrene of a scrotum, Fournier's disease, Fournier's syndrome, idiopathic phlegmon of a scrotum, cellulitis of a scrotum) — the disease which is characterized by an acute necrosis of tissues of penis and a scrotum.

A. Fournier is described in 1883. The disease is rare, but for the last decades its frequency increased.

Etiology and pathogeny. Activators F. associations of anaerobic and aerobic bacteria are: Clostridium (see) — C1. perfringens, Cl. novyi (oedema-tiens), Cl. septicum, Cl. histolyti-cum, a streptococcus (see), colibacillus (see), a protea (see Proteus), staphylococcus (see), etc. One of the main factors promoting progressing of gangrene is staphylococcal hyaluronidase (see). Infection happens in the endogenous or exogenous way. Sometimes F. precede acute or hron. inflammatory diseases of anorectal area (anaerobic paraproctitis, ishiorektalny abscess). Cases of emergence F are known. in the presence of an attrition and an intertrigo in the field of a scrotum, after herniotomy concerning inguinal hernia, an urethrotomy, bougieurage of an urethra, a transurethral biopsy

of a prostate, at patients with a stricture of an urethra, an epididymite, retroperitoneal phlegmon, etc. However often entrance infection atriums do not manage to be revealed.

Pathological anatomy. At F. often there is a total necrosis of skin and subjects of fabrics of a scrotum (see) with an exposure of testicles and seed cords, sometimes a necrosis of skin of a penis (see); in nek-ry cases the necrosis extends to skin of a crotch and the bottom of a stomach. At the same time can arise purulent flow on a crotch and hips.

Microscopically find acute cellulitis with leukocytic neutrophylic infiltrates in hypodermic cellulose, skin limfangiit, trombotichesky arteritis of branches of the outside sexual arteries nourishing skin of a scrotum to-ry is the reason of gangrene.

Clinical picture. The disease can arise at any age, even at newborns. The disease begins sharply. High temperature, sharply expressed phenomena of the general intoxication, euphoria is noted. In the first days of a disease bacteriemic (endotoxic) shock can develop (see). The patient is disturbed by feeling of painful tension in a scrotum, a crotch, in hips. Appears and quickly the hydroscheocele and a penis passing further to an abdominal wall and a crotch accrues. The scrotum considerably increases and takes spherical shape. Skin of a scrotum, a penis and a crotch accepts cyanotic, violet-brown coloring with a black shade; its folds are maleficiated. Frustration of an urination can be observed. In the field of hypostasis palpa-torno the crepitation indicating presence at hypodermic cellulose of gas often is defined. Sometimes urethral and perineal uric fistula develops.

The diagnosis is made on the basis of data by a wedge, inspections. In blood the high leukocytosis and other signs of inflammatory process is noted. Differential diagnosis F. carry out with an erysipelatous inflammation of a scrotum (see), gangrene of a scrotum of other etiology, napr, at an anasarca, an uric zatek at an injury of an urethra or bladder (see. Uric flowed).

Treatment. At F. it is necessary to make urgently multiple linear cuts of skin of a scrotum, a crotch and penis, then — a necrotomy (see). Muddy, and then purulent fetid liquid with vials of gas usually follows from a wound at first transparent, then; bleeding insignificant. Wounds irrigate 4% with solution of hydrogen peroxide or solution of potassium permanganate, rykhlo tampon the gauze napkins moistened with solution of hydrogen peroxide. Intravenously kaiyelno enter antigangrenous serums (see). Appoint antibiotics (see) preferential broad spectrum of activity, constantly controlling sensitivity of microflora to them. Hyperbaric oxygenation is recommended (see). Excision of nekrotizirovanny fabrics is repeated until in wounds pure granulations do not appear. After a granulation of wounds with big skin defects start plastic surgeries. Create skin rags on a front surface of hips and a stomach and with their help close defects of skin of a scrotum and a penis; at a total necrosis of a scrotum testicles place under skin of a front surface of hips. Result of plastic surgeries in most cases good.

Forecast serious. Before emergence of antibiotics a lethality at F. reached 44%. In a crust, time

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on condition of early recognition and complex treatment of a disease using antibiotics of a broad spectrum of activity the forecast became more favorable.

Prevention F. consists in respect for personal hygiene, the prevention and timely treatment of attritions and intertrigo, and also in careful surgical treatment of wounds of a scrotum and a crotch.

See also Mephitic gangrene. Bibliography: B and r to and e in V. V. Odnomo

mentny plastics of skin of a scrotum and a penis at Fournier's disease, Urology, No. 1, page 57, 1964; Berngard Ya.II. and Kopylov Yu. H. Gas gangrene of a scrotum, Vestn. hir., t. 127, No. 8, page 73, 1981; Berutti A., G and of on A. et A u b e of t M. Une nouvelle observation de necrose cutanee des organes genitaux externes masculine (Maladie de Fournier), Ann. Urol., t. 10, p. 237, 1976; Fournier J. A. Gangrene foudroyante de la verge, Med. prat., t. 4, p. 589, 1883;

Jones R. B. a. o. Fournier’s syndrome, necrotizing subcutaneous infection of the male genitalia, J. Urol. (Baltimore), v. 122, p. 279, 1979; L e Guyader A. e. a. A propos de 90 cas de gangrene des organes genitaux externes observes an Abidjan en 10 ans, Chirurgie (Paris), t. 106, p. 583, 1980; Me Donald D. F.,

H u 1 e t W. H. a. Cowan J. W. Scrotal gangrene treated with oxygen under high pressure, J. Urol. (Baltimore), v. 113, p. 364, 1975.

A. Ya. Pytel.

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