Diferencias en los patrones de atención entre los hospitales con bajo y alto volumen de casos en el manejo de la gangrena de Fournier. Introduction: Fournier’s gangrene is a rare and serious disease, which is characterized by necrotizing, synergistic and polymicrobial fasciitis and maintains high. Request PDF on ResearchGate | Gangrena de Fournier | Introduction Fournier’s gangrene is a subcutaneous necrotizing infection of urogenital or anorectal.
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Fournier gangrene is an acute necrotic infection of the scrotum; penis; or perineum. It is characterized by scrotum pain and redness with rapid progression to gangrene and sloughing of tissue. Fournier gangrene is usually secondary to perirectal or periurethral infections associated fouier local trauma, operative procedures, or urinary tract disease. Sincemore than 1, cases for study have been reported in English language medical literature.
Gangrena de Fournier en un procedimiento ginecológico – Artículos – IntraMed
This disease occurs worldwide and, although it is recognized more frequently among male adults, has been identified also among women and children. Treatment usually consists of the ganrgena removal debridement of extensive areas of dead tissue necrosis, necrotic and the administration of broad-spectrum intravenous antibiotics.
Surgical reconstruction may follow where necessary. Symptoms include fever, general discomfort malaisemoderate to severe pain and swelling in the genital and anal areas perineal followed by rankness and smell of the affected tissues fetid suppuration leading to full blown fulminating gangrene.
Rubbing the affected area yields the distinct sounds crepitus of gas in the wound and of tissues moving against one another palpable crepitus. In severe cases, the death of tissue can extend to parts of the thighs, through the abdominal wall and up to the chest wall. This disease is commonly found in conjunction with other disorders comorbidityespecially those that weaken the immune system. Some disorders that increase the predisposition to Fournier gangrene are diabetes mellitus, profound obesity, cirrhosis, interference with the blood supply to the pelvis, and various malignancies.
Anorectal abscesses, urinary tract infections, surgical instrumentation and other contributing factors have all been implicated.
Some cases continue to be of unknown cause idiopathic. Why this process occasionally develops in individuals with common ailments is still not understood.
There are many ways for the virulent microorganism to gain access to the host, where the compromised immunological system is unable to prevent the infection from taking hold. The virulence of the resulting disorder is thought to be enhanced by the toxins and enzymes produced by the combination of microorganisms synergy. The mean age of presentation is about 50 years, but the range of patient ages in reported cases is from eight days to 90 years.
Fournier gangrene is diagnosed more frequently among males. It may be that the high male to female ratio in the diagnosis is the result of the lack of recognition of this entity among women by physicians. It is believed that the male to female proportion may be anywhere from 5: Symptoms of the following disorders can be similar to those of Fournier gangrene.
Comparisons may be useful for a differential diagnosis.
Epididymitis is inflammation of the long, tightly coiled tube behind each testicle epididymis that carries sperm from the testicle to the spermatic duct. Affected individuals usually have painful swelling of the one epididymitis and the associated testicle.
Gangrena de Fournier
In some cases, the second testicle may also be tender. The two main forms of epididymitis are the sexually-transmitted form and the nonspecific bacterial form.
Gas gangrene is a severe form of tissue death usually caused by bacteria that do not need oxygen anaerobes to survive, such as Clostridium perfringens.
It can also result from infections caused by Group A Streptococcus bacteria and Staphlococcus aureus and Vibrio vulnificus. Clostridium bacteria in an environment of low oxygen concentration produce toxins that cause tissue death and associated symptoms.
Gas gangrene is rare, with only 1, to 3, cases occurring in the United States annually. Hydrocele is a fluid-filled sack along the spermatic cord within the scrotum. Hydroceles are common in the newborn infant. They may be unilateral or bilateral and result when there is failure of the tract through which the testis descends from the abdomen into the scrotum to close.
Peritoneal fluid drains through the open tract from the abdomen into the scrotum where it becomes trapped causing enlargement of the scrotum. Hydroceles may also be caused by inflammation or trauma of the testicle or epididymis or by fluid or blood obstruction within the spermatic cord. The incidence of this type of hydrocele is higher in older men. Orchitis is an inflammation of one or both of the testicles, often caused by infection. Orchitis may be caused by numerous bacterial and viral organisms.
It is usually a consequence of epididymitis see above. The most common viral cause of orchitis is mumps. It is most common in post-pubertal boys rare before 10 years of age. It usually manifests 4 to 6 days after the onset of mumps.
In one-third of boys who get orchitis caused by mumps, testicular atrophy shrinking of the testicles will result. Debilitating illnesses, such as diabetes, alcoholism, HIV infection, and malnutrition seem to increase the susceptibility of a person to Fournier gangrene but are not related disorders.
The diagnosis is basically made on clinical findings. Ultrasound evaluation may achieve early differentiation between Fournier gangrene and an acute inflammatory process, such as epididymitis or orchitis.
Computed tomography may help to determine the portal of entry and extension of the process, but is not indispensable and should not delay surgical treatment. X-ray studies are useful to confirm the location and extent of gas distribution in the wounds.
Computerized tomographic CT images are preferred because they resolve smaller amounts of soft tissue gases and fluids. It is critical to recognize the disorder and to initiate aggressive resuscitation and administration of broad-spectrum intravenous antibiotics as quickly ganrena possible. Such antibiotics must be followed by urgent surgical debridement of all affected dead necrotic skin and subcutaneous tissue involved, with repeated removal of wound margins as necessary.
If colorectal or urogenital origin is established, source control is imperative, in accordance with each case. Patients with severe blood infection sepsis are at increased risk for developing blood clots thrombembolic phenomena and may require medication to reduce the risk for thrombosis Reconstructive surgery is undertaken, once infection is under control.
Colostomy remains founuer as a means of decreasing fecal contamination.
Foley catheters generally get rid of urine adequately. When available, a burn center may be a good location for the treatment of patients with necrotizing soft-tissue surgical infections, including Fournier gangrene. Information on current clinical trials is posted on the Internet at www.
All studies receiving U. For information about clinical trials sponsored by private sources, contact: For information about clinical trials conducted in Europe, contact: Complex wounds and their management.
Gangrena de Fournier | Cigna
Surg Clin North Am. Hyperbaric oxygen therapy in acute necrotizing infections with a special reference to the effects on tissue gas tensions. Ann Chir Gynaecol Suppl. Burn center management of necrotizing soft-tissue surgical infections in unburned patients. La Gangrena de Fournier: Last Update November 12, The content of the website and databases of the National Organization for Rare Disorders NORD is copyrighted and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from NORD.
About News Events Contact. Synonyms of Fournier Gangrene Fournier disease Fournier’s disease Fourniers disease Fournier’s gangrene Fourniers gangrene gangrene, Fournier gangrene, Fournier’s necrotizing fasciitis of the perineum and genitalia synergistic necrotizing fasciitis of the perineum and genitalia.
General Discussion Fournier gangrene is an acute necrotic infection of the scrotum; penis; or perineum.
Affected Populations The mean age of presentation is about 50 years, but the range of patient ages in reported cases is from eight days to 90 years. Related Disorders Symptoms of the following disorders can be similar to those of Fournier gangrene. Diagnosis The diagnosis is basically made on clinical findings. Standard Therapies Treatment It is critical to recognize the disorder and to initiate aggressive resuscitation and administration of broad-spectrum intravenous antibiotics as quickly as possible.
Investigational Therapies Information on current clinical trials is posted on the Internet at www. Mopurgo E, Galandiuk S. Years Published, Alone we are rare. Together we are strong.