Open Access Emergency Medicine (Nov 2020)
Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives
Abstract
Jonathan Auerbach,1 Kasha Bornstein,1 Mark Ramzy,2 Jorge Cabrera,1 Tim Montrief,2 Brit Long3 1Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA; 2Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 3Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, TX, USACorrespondence: Tim MontriefUniversity of Pittsburgh, 3550 Terrace Street, 644A Scaife Hall, Pittsburgh, PA 15261, USATel +1 517 260 5629Fax +1 515 203 4625Email [email protected]: Fournier gangrene (FG) is a rare and life-threatening urosurgical emergency characterized most often by a polymicrobial infection of the perineal, genital, or perianal region. FG has an increased incidence in male patients, patients with alcoholism, and patients with immunocompromise including human immunodeficiency virus (HIV) and uncontrolled diabetes. FG often begins as a simple abscess or cellulitis with progression to necrotizing soft tissue infection (NSTI). Delays in diagnosis and treatment confer high mortality. Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle. The most significant modifiable risk factor associated with NSTI mortality is delay to surgical intervention. Coordination of both inpatient medical and surgical teams to implement appropriate therapy is vital to successful outcomes. The emergency medicine clinician must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management. The objective of this review is to provide updated and relevant information regarding recognition, diagnosis, and management of FG for the emergency medicine provider.Keywords: necrotizing soft tissue infections, infectious disease, necrotizing fasciitis, emergency
