4 Fournier ’ s Gangrene

Fournier’s gangrene (FG) is an acute, rapidly progressive and potentially fatal, infective necrotizing fasciitis affecting the external genitalia, perineal or perianal regions1. The definition of FG changed more often than the treatment over the years. Professor JeanAlfred Fournier (1832-1914), first defined FG as an ‘acute idiopathic gangrene of the scrotum in the young male2. The frequent isolation of causative organisms led to the first modification. Observation that the elderly with certain co-morbidities are more often affected along with reports in women went a long way in modifying the description of FG3. FG is a disease of antiquity. King Herod of Judea was suspected to have suffered from genital gangrene in association with diabetes mellitus 4. Over the decades, FG has proved to be an enigma to the physician and an embarrassment to the patient. In 1764, Baurienne originally described an idiopathic, rapidly progressive soft-tissue necrotizing process that led to gangrene of the male genitalia. However, Jean-Alfred Fournier, a Parisian venereologist, is more commonly associated with this disease, which bears his name. In one of Fournier’s clinical lectures in 1883, he presented a case of perineal gangrene in an otherwise healthy young man5. Since Fournier’s description, subsequent experience has shown that, in most cases, Fournier gangrene has an identifiable cause and that it frequently manifests more indolently. Trauma to the genitalia continues to be a frequently recognized vector for the introduction of bacteria that initiate the infectious process5. The disease carries a significant mortality. The mortality from FG has shown no correlation with advancement in medical services. An unpublished report indicates a paradoxically higher mortality rate in developed countries compared to developing ones.