A Case of Fournier's Gangrene

Sara E. Champion, MSN, RN, FNP-C, CUNP

Disclosures

Urol Nurs. 2007;27(4):296-299. 

In This Article

Signs and Symptoms

Although the average number of days before diagnosis is 5, the progression of Fournier's gangrene is fairly predictable (Thomsen & Legome, 2005). The onset is insidious with preliminary symptoms observed between 2 and 7 days (Yalamarthi & Dayal, 2006). Pain is generally the first symptom and may be unaccompanied by any significant cutaneous findings, as the infection begins in the underlying tissues. In most cases, the pain is out of proportion to visible signs. Fever may go along with the initial pain or follow shortly. Next, rapid, widespread edema of the surrounding tissue occurs, and the overlying skin takes on a highly erythematous appearance. As the necrosis progresses to the nerve endings in the affected tissue, there is resulting loss of sensation. The overlying skin be comes friable and dark maroon, bluish, or black, and bullae may develop. Soon after, a thin clear discharge may be noted. This discharge is sometimes referred to as "dirty dishwater fluid," and a sweet, sickly odor associated with anaerobic respiration may be present. Crepitus may also be appreciated on palpation due to the gases released. At this stage, changes in the blood work are generally significant with an elevated WBC >16, hemoglobin <10, platelets <150, sodium <135, calcium <8.4, arterial pH <7.35, and increased prothrombin and partial thromboplastin times (Moses, 2005). Complications including disseminated intravascular coagulopathy, renal failure, sepsis, ketoacidosis, and eventually multiple organ failure occur if not urgently treated. The Fournier's Gangrene Severity Index developed by C.O. Yeniyol in 2000 is useful in predicting outcomes of patients admitted with the disease (Lin et al. 2005; Tuncel et al., 2006; Yeniyol, Suelozgen, Arslan, & Ayder, 2004). Table 4 displays the severity index variables.

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