What happens in tissues
The infection is caused not by one microbe, but by a mixed flora: aerobic and anaerobic bacteria act together. They secrete enzymes that destroy connective tissue and cause thrombosis of small vessels of the skin and subcutaneous tissue. Due to the cessation of blood flow, tissues die, and antibiotics stop flowing there. The infection spreads through the fascial spaces at high speed, so the outer border of redness is always less than the actual volume of the lesion. At the same time, decay products enter the blood and cause sepsis, which impairs the functioning of the kidneys, lungs and coagulation system.
- Mixed aerobic-anaerobic infection
- Vascular thrombosis and tissue necrosis
- Spread through fascia faster than through skin
- Development of sepsis and multiple organ failure
- Antibiotics are ineffective without surgery
Causes and risk factors
The entrance gates are damage to the skin of the perineum, anorectal ulcers, inflammatory processes of the genitourinary organs, traces after operations or injections. Sometimes an obvious reason cannot be found. The background against which the disease develops is much more important: diabetes mellitus occurs in a significant proportion of patients, since high sugar disrupts the functioning of immune cells and blood supply to tissues. Contributors include obesity, alcohol abuse, chronic liver and kidney diseases, and use of immunosuppressants.
- Diabetes mellitus
- Paraproctitis, anal fissures, hemorrhoids with suppuration
- Urinary tract infections and perineal injuries
- Obesity and inactivity
- Alcohol abuse
- Immunodeficiency and use of immunosuppressants
- Old age
How to recognize in time
In the first hours, the disease is disguised as ordinary inflammation: swelling and redness of the scrotum or perineum, discomfort, and low temperature appear. A rapid increase in symptoms over several hours and very severe pain that does not correspond to the appearance of the skin should be alarming. Then dark spots, blisters, areas with loss of sensitivity, an unpleasant odor appear, and the general condition worsens sharply. If these signs appear, you should immediately call an ambulance by number 103 and do not try to get treatment at home.
- Rapid increase in swelling over hours
- The pain is worse than expected by appearance
- Darkening of the skin, blisters, foul-smelling discharge
- Crunching under the fingers when palpated
- High fever and confusion
- No effect from home remedies
Diagnostics
The diagnosis is primarily clinical: an experienced surgeon makes it by examination, and if the picture is obvious, the operation is not postponed for the sake of examination. Laboratory tests show severe inflammation, clotting abnormalities, often high blood sugar, and signs of kidney damage. Ultrasound and computed tomography help assess the extent of the process and detect gas in tissues, which is especially valuable when the picture is unclear. Material from the wound must be sent for culture in order to accurately select antibiotics.
- Urgent examination by a surgeon and urologist
- General blood test and biochemistry
- Glucose and glycated hemoglobin
- Ultrasound of soft tissues
- CT scan of the pelvis and perineum with an unclear picture
- Culture of discharge with sensitivity determination
Treatment
The basis of treatment is an emergency operation, in which all dead tissue is removed to healthy ones, the leaks are opened and the wound is left open for drainage. One operation is often not enough: revisions are repeated daily until the process is stopped. At the same time, broad-spectrum antibiotics are administered, intensive therapy is carried out, and diabetes mellitus is compensated. Sometimes it is necessary to temporarily drain urine or feces to prevent the wound from becoming contaminated. After the infection subsides, plastic surgery is performed to close the defect. Recovery takes weeks and months, but if treatment is started in a timely manner, the chances are significantly higher.
- Emergency surgical removal of dead tissue
- Repeated wound revisions
- Broad-spectrum antibiotics intravenously
- Intensive care and diabetes management
- Diversion of urine or feces if necessary
- Dressings and modern wound coverings
- Reconstructive operations at the final stage
