Gangrene Fournier is a rare, but rather dangerous disease. The pathology of an infectious nature is accompanied by a rapid course due to an abnormally fast multiplication of bacteria in the external genital organs, as well as necrosis and atrophy of scrotum tissue.
First mention
The first to describe this pathology was the French doctor J. A. Fournier in 1883. He documented the symptoms of a disease that leads to progressive gangrene in healthy young people for no apparent reason. The scientific name for the pathology is polymicrobial necrotic fasciitis. The disease develops in the perineum, scrotum, or in the anus. Photos of Fournier gangrene look intimidating.
Causes
To date, the disease has been thoroughly studied and described. According to statistics, this pathology is encountered not only by patients at a young age, but also by more mature and elderly people. This allows us to conclude that the development of the disease does not depend on the age of the man.
Among women, Fournier gangrene is extremely rare. The main prerequisite for its occurrence is the weakening of the body's defense system, which leads to an increase in sensitivity to harmful bacteria. Infectious damage occurs, as a rule, against the background of trauma to the external genital organs.
The causes of Fournier gangrene should be determined by the doctor.
Infection
In the vast majority of cases, the development of gangrene in the scrotum is the result of an infectious disease. Pathogens can enter not only through trauma, but also through the rectum or urethra. This process may be preceded by:
1. Abscesses that arose on the skin around the anus, on the mucous membranes of the rectum, etc.
2. Cracks in the anus.
3. Perforation of the rectum.
Pathology of the urogenital type can occur as a result of the inflammatory process or trauma to the urethra, appendages or testicles, as well as as a result of infection of the genitourinary system.
A photo of Fournier gangrene in men confirms that this is an extremely serious and dangerous disease.
Dermatological variety
The dermatological variety of gangrene appears against the background of penetrating genital wounds or due to non-compliance with personal hygiene rules. Secondary factors that provoke gangrene of the genital organs are:
Wounds and deep scratches on the skin of the genitals.
Tattoos and piercings in the intimate area.
The introduction of drugs into the penis.
Installation of implants.
Intestinal cleansing through enemas with steroid drugs.
The presence of a foreign object in the anus.
Features in women
There are certain features of a Fournier gangrene in a woman. The reasons for its appearance may be:
Abscess after abortion.
Inflammation of the bartholin glands of a purulent kind.
Uterus removal operation.
Dissection of the perineum during childbirth.
Anal intercourse increases the risk of developing the disease in both sexes several times.
In children
A child can also encounter Fournier gangrene. This occurs in the following cases:
Circumcision of the foreskin.
Injury of an inguinal hernia.
The inflammatory process after insect bites.
Genital injuries.
Infections of the genitourinary system in a chronic form.
In addition, Fournier’s disease can become a complication of omphalitis, that is, infection of the umbilical wound, as well as abdominal tissues in newborns.
The symptoms of Fournier gangrene are quite specific (the photo on the pages of medical publications confirms this).
Symptoms
The main sign of pathology is acute pain, as well as increased sensitivity in the intimate area. The clinical picture of the pathology is described as follows:
1. An increase in body temperature, drowsiness, chills, weakness and other symptoms of fever. Duration from two days to a week.
2. Progressive soreness caused by swelling of the skin in the area of ​​abscess formation, itching.
3. Severe damage to tissues located around the pathological area.
4. Change the color of the skin to red, lilac, cyanotic up to a black shade.
5. The allocation of purulent contents from the wound or internal tears of the epidermis.
Patients with signs of Fournier gangrene note that soreness tends to lose its severity over time. They perceive this as a sign of improvement in their condition. However, on the contrary, this indicates the progression of a pathology that affects new nerve endings and tissues, which reduces the sensitivity of the affected area and reduces soreness.
Examination of the physiological state of the patient plays a very important role in the diagnosis. On palpation, the specialist must correctly determine the presence of symptoms of Fournier's disease. If during the examination revealed increased softness, tissue damage and sensitivity, it is necessary to conduct differential diagnosis in order to prescribe timely treatment. What other symptoms of Fournier gangrene are?
Skin symptoms
The skin around the affected area under the influence of gangrene has the following features:
1. Swelling.
2. Purple, cyanotic or copper tint.
3. Blisters.
4. Pronounced signs of tissue necrosis.
It is also possible to maintain a healthy appearance of tissues, which, as a rule, misleads the specialist and leads to late recognition of the disease, significantly reducing the chances of a successful recovery. Not always accompanied by gangrene with an unpleasant odor. Quite often, patients complain about heart rhythm disturbances, fever and high blood pressure, which are standard symptoms of a viral disease.
Diagnostics
Diagnosis of Fournier gangrene is carried out using standard laboratory tests, as well as through special techniques. Treatment is prescribed solely on the basis of the results of the examination. The main diagnostic methods are:
1. A blood test that counts bloodstream cells such as white blood cells, platelets, and red blood cells.
2. The study of the level of gas in the blood from the artery.
3. Urinalysis.
4. Blood coagulation test.
5. Sowing separable contents.
The gas level indicates the state of the person’s respiratory function, and also allows you to assess the acid-base balance in the body. A change in these indicators compared with the norm may indicate the presence of necrotic processes in the body. A coagulation test shows an increase in platelets, which is also one of the signs of gangrene. Bacteriological culture makes it possible to identify pathogens and determine their resistance to antibiotics. Thus, it will be possible to choose the most suitable antibacterial drugs.
The final diagnosis is made only on the basis of the examination and laboratory tests. As additional methods, x-rays and computed tomography, which show the degree of damage to the internal organs, can be used. Other methods the doctor prescribes depending on the clinical picture of a particular patient.
Treatment
Fournier gangrene treatment should be comprehensive. It provides for several stages. An integral part of the treatment is surgical intervention. This is due to the fact that only after gaining access to the internal tissues, it will be possible to confirm the diagnosis and remove the tissues that managed to undergo a necrotic process. The risk of death is reduced several times if surgery is performed in a timely manner.
If intoxication of the body occurs, which is explained by a deficient blood supply to the affected organ, resuscitation may be necessary in order to restore blood flow and access to nutrient tissues. Therapy is carried out without fail in stationary conditions. The patient is in the intensive care unit before surgery, and then transferred to surgery.
Antibacterial drugs
In addition to surgery, the patient is prescribed antibacterial drugs. It can be administered either orally or by injection. With the development of gangrene against the background of an injury, tetanus vaccination may be required. If the patient has a history of chronic diseases, such as diabetes, genitourinary infections, HIV, etc., it is mandatory to check the indicators for these pathologies. According to statistics, it is these diseases that are provoking factors in the development of gangrene. Also, complications and worsening of the patient's condition in the presence of these diseases are not excluded.
After dissecting the affected area with Fournier gangrene in women, we can talk about establishing a final diagnosis. If gangrene is confirmed, removal of all dead tissue is mandatory. The use of electrocoagulation reduces the risk of bleeding and speeds up the process of surgery.
During the operation, the surgeon's task is to preserve the reproductive organs of the patient, if possible. However, if the clinical picture does not allow, the affected tissue is removed. In the future, the intervention of plastic surgeons may be required to restore the anatomical appearance of the organs.
Forecast
The help of plastic surgeons will need to be resorted to in the event that the previous operation left extensive cosmetic defects. For some patients, the result of the operation is damage to organs located in the immediate vicinity of the affected area, as well as in the lower abdomen and on the inner surface of the thigh.
The prognosis for a full recovery directly depends on the stage of development of the pathology at which treatment is carried out. A doctor can give hope for a complete recovery and preservation of reproductive function only if the patient has applied at an early stage. The scrotum tissues have a high ability to recover, they quickly regenerate from the moment the harmful microflora is eliminated.
After treatment with Fournier gangrene, men and women may develop some complications, manifested by pain and discomfort during an erection. This is due to the tension of the scars left by the operation.
Negative gangrene prognoses are characteristic of elderly people of both sexes, in whom large areas of the body were affected. The state of shock, sepsis, and kidney or liver failure can worsen the patient's condition and course of the disease. It is these factors that cause death.
Prevention
There are a number of preventive measures that can prevent the development of the disease. Since bacterial microflora provokes the appearance of gangrene, it is necessary to take all measures to prevent it from entering the body. The first thing to remember is compliance with personal hygiene rules and the availability of your own toiletries.
It is also important to observe cleanliness in the field of intimate relationships. When having sex with an unfamiliar partner, you should use a condom. In case of an injury to the inguinal region, immediately treat the damaged area with an antiseptic. In addition, antibiotic therapy may be required.
Another important preventive moment is to strengthen the human immune system. You should regularly play sports, eat right, give up bad habits, etc. In addition, you can support the body with various vitamin and mineral preparations, immunostimulants, etc.
Another aspect of gangrene prevention is regular preventive examinations by a urologist, which will help to identify developing pathology in time and prevent serious consequences and complications.