Post Date December, 03 2023
Gangrene of scrotum is a very serious and rare acute scrotal infectious diseases. Infection outbreak due to bacterial invasion and scrotal vascular embolism can cause scrotal gangrene within 2 days or even 10 hours. It can be combined with toxic myocarditis and septic shock. If the diagnosis is not timely and the treatment is improper, the patient's life may be endangered.
What causes scrotal gangrene?
（1） Pathogenesis
This disease is an acute infection of the subcutaneous tissue of the scrotum caused by the mixed infection of cocci, bacilli, anaerobes and other bacteria. Common gram-positive cocci include Staphylococcus aureus, hemolytic streptococcus, and fecal streptococcus. Gram-negative bacteria include Escherichia coli, Klebsiella, Proteus, etc. Anaerobic bacteria are mainly Bacteroids. The rapid proliferation of all kinds of bacteria occurs in the superficial fascia layer, and the infection spreads along the fascia surface and produces subcutaneous tissue occlusive endarteritis, leading to tissue necrosis.
（2） Pathogenesis
Pathogen invasion ways: Pathogen mainly invades through the following three ways. ① Direct invasion from scrotal skin, often secondary to scrotal skin injury or infection; ② Urethral infection (mainly the infection of the glands around the urethra) develops to the periphery and spreads along the Darto fascia of the penis sac and the Scarpa fascia of the abdominal wall after penetrating the Buck fascia; ③ Perianal abscess spreads around or retroperitoneal infection spreads along the fascia of the penis and scrotum. Diabetes, cirrhosis and malnutrition are the predisposing factors of the disease.
The manifestations of scrotal gangrene are worse
This disease occurs at any age. It is sudden and often occurs at night. The patient wakes up with severe pain. Local redness, swelling and severe pain of the initial lesion. Necrosis of scrotal skin and subcutaneous tissue occurred from hours to days. Pain can often be relieved after skin necrosis, which may be related to the destruction of peripheral nerves. The lesions are usually confined to the skin and subcutaneous tissue of the scrotum and penis, and can spread to the armpit in serious cases. The depth can reach the whole layer of scrotum. Because of the barrier effect of the white membrane, the testis is generally not affected. In the early stage of physical examination, local redness, swelling and intense tenderness can be seen, and sometimes twisted voice can be felt under the skin. With the progress of the disease, the skin of the scrotum has a flaky necrotic area, which is black, with serous exudation, and further develops into pus. Systemic symptoms mainly include high fever, chills and other infectious toxic shock symptoms, which can lead to death if not treated in time.
According to the typical clinical manifestations, it is not difficult to diagnose the disease. The key is to recognize the characteristics of the disease such as acute onset, rapid scrotal necrosis and severe systemic poisoning. In diagnosis, attention should be paid to finding primary infection foci such as urethral stricture infection and perianal infection.
How should scrotal gangrene be treated and treated?
（1） Treatment
1. In the early stage of systemic treatment, large dose of broad-spectrum antibiotics were given intravenously, and sensitive antibiotics were used after the bacterial culture results of wound secretion were reported. At the same time, dexamethasone and blood transfusion were used, and shock patients were given anti-shock treatment.
2. No matter whether there is obvious necrosis in local treatment, the scrotum skin should be cut at multiple places at early stage, and the drainage wound should be washed and wetted with 1 ∶ 5000 potassium permanganate solution or 3% hydrogen peroxide (hydrogen peroxide) to remove the necrotic tissue in time.
3. Actively treat complications to maintain water, electrolyte and acid-base balance. People with high fever should cool down and pay attention to protecting myocardial function; For those with diabetes and renal function damage, it is necessary to actively control blood sugar and correct renal failure.
4. Skin grafting is still necessary for patients with extensive gangrene, involving the lower abdominal wall and scar contracture of the wound.
5. In recent years, some people think that hyperbaric oxygen treatment should be adopted for anaerobic bacteria, but there is still a lack of comparison on the efficacy.
（2） Prognosis
Scrotal gangrene can occur at any age, with rapid onset and rapid development. If the diagnosis is timely (within 12 hours of onset), the disease can be alleviated and healed quickly after active treatment; If the diagnosis and treatment are made after more than 24 hours of the onset, the scrotal hypotension incision is often difficult to prevent further necrosis, which can invade the testicular sheath, make the testicle exposed, even affect the penis and abdominal wall, and become a severe disease. Therefore, the importance of early diagnosis and timely treatment should be emphasized for this disease. The key link to cure this disease is the comprehensive treatment of the whole body and the local part.
