Fournier's gangrene

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Sunfire

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I'm being attacked by a trolling Resident and need some help.

A Doctor I know who's Director of her ED read through my gunshot trauma paper (albeit years ago) and laughing, said, "What the hell is Fournier's gangrene?"

I've now got people breathing down my neck that, supposedly, any reputable ER MD should know what Fournier's gangrene is.

Is it really so common?

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All I can think is that she knew it under a different name or that she was having an off day. I'm certainly not going to lie and say that she knew what it was, because she didn't.

She is older, and perhaps they called it a different name when she was in school? That's all I can rationally think of.
 
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You're right. Life is learning.


Thanks for the information.
 
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Dude, I've read said paper and it made me feel embarrassed for you. Maybe she was joking with you because she didn't take you seriously.
 
Had a case a few weeks ago actually.

Maybe it was meant sarcastically?
 
I was on call when one came in the ED. That makes it common.
 
Fournier's Gangrene

Fournier's gangrene, sometimes called Fournier's disease, is a bacterial infection of the skin that affects the genitals and perineum (i.e., area between the scrotum and anus in men and between the vulva and anus in women).The disease develops after a wound or abrasion becomes infected.

A combination of anaerobic (living without oxygen) microorganisms (e.g., staphylococcal) and fungi (e.g., yeast) causes an infection that spreads quickly and causes destruction (necrosis) of skin, tissue under the skin (subcutaneous tissue), and muscle. Staphylococcal bacteria clot the blood, depriving surrounding tissue of oxygen. The anaerobic bacteria thrive in this oxygen-depleted environment and produce molecules that instigate chemical reactions (enzymes) that further the spread of the infection. Fournier's gangrene can be fatal if the infection enters the bloodstream.

Incidence and Prevalence
Men are ten times more likely than women to develop Fournier's gangrene. Men aged 60-80 with a predisposing condition are most susceptible.

Women who have had a pus-producing bacterial infection (abscess) in the vaginal area, a surgical incision in the vagina and perineum to prevent tearing of skin during delivery of a child (episiotomy), an abortion resulting in fever and an infection of the lining of the uterus (septic abortion), or surgical removal of the uterus (hysterectomy) are susceptible.

Rarely, children may develop Fournier's gangrene as a complication from a burn, circumcision, or an insect bite.

Risk Factors

Men with alcoholism, diabetes mellitus, leukemia, morbid obesity, and immune system disorders (e.g., HIV, Crohn's disease), and intravenous drug users are at increased risk for developing Fournier's gangrene. The condition also can develop as a complication of surgery.

Causes

Fournier's gangrene develops when bacteria infect the body through a wound, usually in the perineum, the tube that carries urine outside the body from the bladder (urethra), or the colorectal area. Existing immune system deficiencies help infection to spread quickly, producing a disease that destroys the skin and superficial and deep fascia (membranes that separate muscles and protect nerves and vessels) of the genital area

Oh, and...

"The chambers in the penis that fill with blood to create an erection (corpora cavernosa), testicles, and urethra are not usually affected."

Good thing, that.

Sounds like you'd have to have a very unusual gunshot would for it to lead to this particular disorder.

I too had never heard of it, but I have a particular hatred of syndromes named after people.

I hereby decree that it shall be henceforth called "polymicrobial perineal necrotizing fasciitis", or PPNF syndrome.
 
Testes may not be infected, but if you're the one implanting them in someone's thigh, you might think that infected and affected have completely different meanings at that point.
 
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