Necrotizing Fasciitis

Today we saw a case of necrotizing fasciitis (see previously blogged). This case was in the abdominal wall and perineum of a female patient with obesity and diabetes, and is likely polymicrobial (type I).

While people often use 'Fournier's' gangrene to infer disease in males that involves the scrotum, the disease entity, involving the pereneum does occur in women. In fact, women seem to have higher mortality, possibly because of involvement of the retroperitoneal space due to anatomic differences and also due to delays in diagnosis. This article also suggests that disease in females is underrecognized, and that ano-rectal disease is far more dangerous precipitant than urological disease.

Death and amputation are more likely at extremes of age, with advancing comorbidities (including diabetes), with sepsis, and with visible gangrene on presentation.