What causes Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Although originally described as idiopathic gangrene of the genitalia, Fournier gangrene has an identifiable cause in 75-95% of cases. [15] The necrotizing process commonly originates from an infection in the anorectum, the urogenital tract, or the skin of the genitalia. [16]

Anorectal causes of Fournier gangrene include perianal, perirectal, and ischiorectal abscesses; anal fissures; anal fistula; and colonic perforations. These may be a consequence of colorectal injury or a complication of colorectal malignancy, [17, 18] inflammatory bowel disease, [19] colonic diverticulitis, or appendicitis.

A case of Fournier gangrene was reported in a patient with COVID-19 following prolonged and repeated ventilation in prone position. [20]

Urogenital tract causes include the following:

  • Infection in the bulbourethral glands
  • Urethral injury
  • Iatrogenic injury secondary to urethral stricture manipulation
  • Epididymitis
  • Orchitis
  • Lower urinary tract infection (eg, in patients with long-term indwelling urethral catheters)

Dermatologic causes include hidradenitis suppurativa, ulceration due to scrotal pressure, and trauma. Inability to practice adequate perineal hygiene, such as in paraplegic patients, results in increased risk.

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