FOURNIER'S GANGRENE: EARLY RECOGNITION, PRECIPITATING FACTORS, MULTIMODAL MANAGEMENT, AND OUTCOMES
Keywords:
Fournier gangrene; necrotizing fasciitis; debridement; sepsis; perineal infection; negative pressure wound therapy; case reportsAbstract
DOI: https://doi.org/10.46296/gt.v9i18.0394
Abstract
Background: Fournier gangrene (FG) is a rapidly progressive necrotizing infection of the perineum, genital and perianal regions associated with sepsis, major tissue loss and substantial mortality. Objective: To synthesize contemporary clinical evidence and patterns described in case reports regarding presentation, precipitating factors, diagnosis, management and reconstruction. Methods: Integrative review of PubMed/MEDLINE and OpenAlex literature, emphasizing 2020-2026 publications and targeted selection of case reports/series with individual clinical information. Contextual evidence was supplemented with systematic reviews, meta-analyses and guidance on necrotizing soft-tissue infections. Results: Reports illustrate a broad spectrum including diabetes and SGLT2 inhibitor exposure, immunosuppression and transplantation, pregnancy, Crohn disease, anorectal malignancy, mpox infection, urological complications and pediatric presentations. Prompt clinical suspicion and urgent source control through extensive debridement remain pivotal. CT helps define disease extent when it does not delay surgery. Broad-spectrum intravenous antimicrobials, resuscitation, metabolic control and repeated reassessment are essential. Negative-pressure wound therapy can facilitate wound management, while hyperbaric oxygen may be considered as an adjunct without delaying surgery. Conclusions: FG requires emergency multidisciplinary management. Case reports are valuable to recognize atypical phenotypes but cannot establish comparative treatment effectiveness on their own.
Keywords: Fournier gangrene; necrotizing fasciitis; debridement; sepsis; perineal infection; negative pressure wound therapy; case reports.
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References
Sartelli M, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg. 2022;17:3. doi:10.1186/s13017-022-00406-2.
Sartelli M, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018;13:58. doi:10.1186/s13017-018-0219-9.
Bowen D, Hughes T, Juliebø-Jones P, Somani B. Fournier's gangrene: a review of predictive scoring systems and practical guide for patient management. Ther Adv Infect Dis. 2024;11:20499361241238521. doi:10.1177/20499361241238521.
Elbeddini A, Gallinger J, Davey M, et al. A Case of Fournier's Gangrene in a Patient Taking Canagliflozin for the Treatment of Type II Diabetes Mellitus. Am J Case Rep. 2020;21:e920115. doi:10.12659/AJCR.920115.
Elbeddini A, Tayefehchamani Y, Davey M, et al. Fournier's gangrene with dapagliflozin in a rural hospital: a case report. BMJ Case Rep. 2021;14(2):e237784. doi:10.1136/bcr-2020-237784.
Moon JY, Lee MR, Kim JH, Ha GW. Fournier Gangrene in a Patient With Type 2 Diabetes Mellitus Treated With Dapagliflozin: A Case Report. Ann Coloproctol. 2021;37(Suppl 1):S48-S50. doi:10.3393/ac.2020.06.22.
Duarte I, Outerelo C, Santana A, Guerra J. Fournier Gangrene as a Complication of a Perinephric Abscess After Kidney Transplant: A Case Report. Transplant Proc. 2021;53(4):1281-1283. doi:10.1016/j.transproceed.2021.02.009.
Larsen K, Paige A, Mutyala M, Weber B, Slim J. Fournier's gangrene mimicking an acute epididymitis. SAGE Open Med Case Rep. 2021;9:2050313X211059297. doi:10.1177/2050313X211059297.
Kostovski O, Spasovska O, Trajkovski G, et al. Challenging Treatment of a Female Patient with Extensive Fournier's Gangrene - Case Report. Prague Med Rep. 2021;122(1):39-44. doi:10.14712/23362936.2021.5.
Tripoli M, Cammarata E, Cordova A. Fournier's gangrene secondary to male circumcision - a case report and review of the literature. Acta Chir Plast. 2021;63(3):96-101. doi:10.48095/ccachp202196.
Yamakawa S, Fujioka M, Fukui K, et al. Fournier's Gangrene With Subcutaneous Emphysema of the Thigh Caused by Air Inflow Associated With a Rectovaginal Fistula: A Case Report of Pseudo-gas Gangrene. Wounds. 2021;33(1):E10-E13.
Sobrado LF, Averbach P, Jayme VR, et al. Fournier's Gangrene During Pregnancy in a Patient with Crohn's Disease. Am J Case Rep. 2022;23:e934942. doi:10.12659/AJCR.934942.
Basukala S, Khand Y, Pahari S, Shah KB, Shah A. A rare case of retroperitoneal extension in Fournier's gangrene: A case report and review of literature. Ann Med Surg (Lond). 2022;77:103595. doi:10.1016/j.amsu.2022.103595.
Bayileyegn NS, Tareke AA. Fournier's gangrene in an eight-day-old male neonate, a case report. Int J Surg Case Rep. 2022;94:106982. doi:10.1016/j.ijscr.2022.106982.
Almaiman SS, Alfraidi OB, Alhathal NK. Fulminant corporal infection induced by Fournier gangrene: A case report with unusual presentation. Urol Case Rep. 2022;40:101942. doi:10.1016/j.eucr.2021.101942.
Bakalli I, Heta S, Kola E, Celaj E. Fournier gangrene in an infant, complicated with severe sepsis and liver dysfunction: A case report. World J Clin Cases. 2023;11(30):7398-7402. doi:10.12998/wjcc.v11.i30.7398.
Paynter JA, Qin KR, Situ D, Lee CHA. Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report. Ann Coloproctol. 2023;39(5):421-426. doi:10.3393/ac.2022.00192.0027.
Müssgens C, Wimmer L, Fankhauser CD, Schneidewind L, Aschwanden FJ. Defining the Standard of Care in Fournier's Gangrene-An Umbrella Review. Eur Urol Open Sci. 2026;83:64-71. doi:10.1016/j.euros.2025.11.009.
Adli G, Kloping YP, Djatisoesanto W. Comparing scoring systems for Fournier gangrenes in predicting morbidity and mortality: Is FGSI still reliable? Fr J Urol. 2024;34:102673. doi:10.1016/j.fjurol.2024.102673.
Arıkan Y, Emir B, Tarhan O, et al. Comparative analysis of scoring systems for predicting mortality in Fournier gangrene: single center, 15 years experience. Updates Surg. 2024;76(7):2683-2692. doi:10.1007/s13304-024-02021-z.
Tufano A, Dipinto P, Passaro F, et al. The Value of Fournier's Gangrene Scoring Systems on Admission to Predict Mortality: A Systematic Review and Meta-Analysis. J Pers Med. 2023;13(9):1283. doi:10.3390/jpm13091283.
Raizandha MA, Hidayatullah F, Kloping YP, et al. The role of hyperbaric oxygen therapy in Fournier's Gangrene: A systematic review and meta-analysis of observational studies. Int Braz J Urol. 2022;48(5):771-781. doi:10.1590/S1677-5538.IBJU.2022.0119.
Patel A, Batura D. Hyperbaric oxygen therapy and Fournier's gangrene: a systematic review and meta-analysis. Med Gas Res. 2026;16(4):508-513. doi:10.4103/mgr.MEDGASRES-D-25-00227.
Susini P, Marcaccini G, Efica J, et al. Fournier's Gangrene Surgical Reconstruction: A Systematic Review. J Clin Med. 2024;13(14):4085. doi:10.3390/jcm13144085.
Kerkemeyer KLS, Bunker CB, Pang KH, et al. Fournier's gangrene of the penis complicating both COVID-19- and Mpox-related genital ulceration - A case report. Int J STD AIDS. 2024;35(3):228-230. doi:10.1177/09564624231208728.
Zubair R, Azam AM, Fatima M, et al. Fournier's gangrene in a female: A case report. SAGE Open Med Case Rep. 2024;12:2050313X241243276. doi:10.1177/2050313X241243276.
Kritharides N, Fouzas M, Stoupa A, et al. Fournier's Gangrene Associated With Untreated Crohn's Disease in a Male Patient: A Case Report and Review of the Literature. Cureus. 2024;16(8):e67515. doi:10.7759/cureus.67515.
Neri M, Ferrari PA, Sanna E, et al. Fournier's gangrene in a woman with chronic neutropenia presenting at 12 weeks of pregnancy: a case report and literature review. Case Rep Womens Health. 2025;46:e00721. doi:10.1016/j.crwh.2025.e00721.
Lee Y, Kim K, Park C, et al. Fournier's gangrene with anal cancer: a case report and literature review. J Surg Case Rep. 2025;2025(8):rjaf573. doi:10.1093/jscr/rjaf573.
Dawit AM, Kiflom DM, Demessie MM, et al. Management of a challenging open urethral defect in a patient with Fournier's gangrene: A case report. Int J Surg Case Rep. 2025;134:111686. doi:10.1016/j.ijscr.2025.111686.
Azmi YA, Alkaff FF, Soetanto KM, Wirjopranoto S, Postma MJ, Purba AKR. The impact of sodium-glucose cotransporter-2 inhibitors on the incidence, therapy, and outcomes of Fournier gangrene: insights from a systematic review of case reports. Syst Rev. 2025;14(1):25. doi:10.1186/s13643-024-02746-3.
Abbasi B, et al. Higher Morbidity and Mortality in Females With Fournier Gangrene Compared With Males: Insights From National Inpatient Sample Data. J Urol. 2025;213(1):99-109. doi:10.1097/JU.0000000000004264.
El Hajjar C, Al Hassan J, Siblini M, et al. Comprehensive management and outcomes in female patients with Fournier's gangrene: A case report. SAGE Open Med Case Rep. 2024;12:2050313X241271829. doi:10.1177/2050313X241271829.
Post catheterization Fournier's gangrene involving the entire anterior urethra: case report. Int J Surg Case Rep. 2024. doi:10.1016/j.ijscr.2024.109448.
El Abidi H, Ibrahimi A, Tariqi R, et al. Fournier's gangrene with corpus spongiosum necrosis following obstructive emphysematous pyelonephritis: An exceptional and severe urological complication. Urol Case Rep. 2024. doi:10.1016/j.eucr.2024.102913.
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