Fournier’s gangrene. History, terminology, epidemiology, predisposing factors, etiology and pathogenesis: literature review

Fournier’s gangrene (FG) is extremely rare acute surgical disease, characterized by rapid progression and high mortality (up to 80%). Over the last decade, the incidence of FG increased by 2.2 - 6.4 times, which is associated with an increase in the number immunocompromised patients. The average age of patients with FG steadily increased and is 55.5 years. Local predisposing factors include anatomical features of the structure and blood supply of genitals and perineum. The common predisposing factors leading positions are occupied by diabetes mellitus, chronic alcoholism and chronic renal failure. Sources of infection in FG include diseases and injuries of the colon (20 - 72% of cases), urinary tract (up to 40% of cases), skin and subcutaneous tissue of the external genitalia, perineum and perianal region (up to 25% of cases). The most common cause of FG is perianal abscess (almost 80% of cases). Causative microflora in FG presents microbial associations from 4-5 aerobic and anaerobic microorganisms. The most common causative microorganism is Escherichia coli (more than 50% of cases). Currently, FG is considered as one of the forms of necrotizing fasciitis. In the pathogenesis of FG is given a value of purulent-inflammatory diseases and injuries of the anogenital region, the synergistic action of highly virulent aerobic and anaerobic infections, acute circulatory disorders in the soft tissues of the anogenital region, and decreased immune reactivity. Infectious-inflammatory process with a speed of 2 to 3 cm per hour spreads along fascial sheaths from the perineum to the scrotum, penis, buttocks, thighs and anterior abdominal wall. The defeat of the testicles and penis when FG is observed very rarely: 4.6% and 0.2% of cases.