Scrotal gangrene

　　1. Etiology

　　This disease is an acute infection of the scrotal subcutaneous tissue caused by a mixed infection of various bacteria such as cocci, bacilli, and anaerobic bacteria. Common Gram-positive cocci include Staphylococcus aureus, Streptococcus hemolyticus, Streptococcus faecalis, etc. Gram-negative bacilli include Escherichia coli, Klebsiella, Proteus, etc., and anaerobic bacteria are mainly Bacteroides. The rapid proliferation of various bacteria occurs in the superficial fascial layer. The infection spreads along the fascial surface and produces obliterative endarteritis of the subcutaneous artery, leading to tissue necrosis.

　　2. Pathogenesis

　　Pathogen invasion routes: Pathogens mainly enter through the following 3 routes.

　　(1) Direct invasion from the scrotal skin, often secondary to skin injury or infection of the scrotum;

　　(2) Urethral infection (mainly infection of the periurethral glands) spreading to the surrounding area, breaking through the Buck fascia and spreading along the Darto fascia of the penile sac, the Scarpa fascia of the abdominal wall;

　　(3) Perianal abscess spreading to the surrounding area or retroperitoneal infection spreading along the fascia of the penis and scrotum. Diabetes, liver cirrhosis, malnutrition, and other factors are predisposing factors for this disease.

　　Scrotal gangrene indicates a severe condition, so once diagnosed, active treatment should be carried out to prevent the infection from worsening and causing systemic toxic reaction syndrome. At the same time, it may be accompanied by toxic myocarditis and infectious shock. The occurrence of infectious shock can directly threaten life and has an unfavorable prognosis. Therefore, the focus of treatment for this disease is to provide early, rapid, and adequate antibiotics to minimize the occurrence of the above complications.

　　This disease can occur at any age, with an acute onset, often occurring at night. Patients may wake up due to severe pain. In the early stage, the affected area is red and swollen with severe pain. In a few hours to a few days, necrosis of the scrotal skin and subcutaneous tissue appears. After the skin becomes necrotic, the pain often subsides, which may be related to the destruction of the terminal nerves. The lesion is often limited to the scrotum and the skin and subcutaneous tissue of the penis. In severe cases, it can spread to the armpit, reaching the full thickness of the scrotum. Due to the barrier effect of the white membrane, the testicle is generally not affected. Physical examination in the early stage may show local redness and tenderness, and sometimes crepitus can be felt under the skin. As the condition progresses, the scrotal skin may appear necrotic areas, which are black, with serous exudation, and further develop into pus. Systemic symptoms are mainly manifested as high fever, chills, and other symptoms of infectious toxic shock. If not treated in time, it can lead to death.

　　This disease is an acute infection of the scrotal subcutaneous tissue caused by a mixed infection of various bacteria such as cocci, bacilli, and anaerobic bacteria. It is important to keep the scrotum clean in daily life, but especially when combined with scrotal inflammation and follicular infection, active treatment should be carried out. Early and effective anti-infection treatment can prevent the further aggravation of the above inflammation and trigger the onset of scrotal gangrene.

　　1. Routine blood test:The number of white blood cells in the blood is significantly increased, and the left shift of the nucleus.

　　2. Wound secretion culture:Can grow two or more pathogenic bacteria.

　　3. ESR, C-reactive protein:Due to the obvious infection, ESR is accelerated, and C-reactive protein is significantly increased.

　　1. Light diet, eat more foods rich in vitamins B1, B2, and B6, such as beans, grains, etc.

　　2. A variety of food types, high in protein, vitamins, calories, and easy to digest, such as animal liver, eggs, lean meat, dairy products, seafood, jujube, etc.

　　3. Pay attention to diet, do not eat spicy, alcohol, and刺激性食物. These can cause blood vessel congestion.

　　I. Treatment

　　1. General treatment: Early intravenous infusion of large doses of broad-spectrum antibiotics, and change to sensitive antibiotics after the report of the bacterial culture results of the wound secretion. At the same time, dexamethasone, blood transfusion, and antishock treatment should be given to patients with shock.

　　2. Local treatment: whether there is obvious necrosis or not, multiple incisions of the scrotal skin should be made early, and the wound surface should be flushed and wet-draped with 1:5000 potassium permanganate solution or 3% hydrogen peroxide (peroxide), and necrotic tissue should be cleared in time.

　　3. Active treatment of complications to maintain water and electrolyte and acid-base balance, and to cool down patients with high fever. Attention should be paid to protect myocardial function; for patients with diabetes and renal dysfunction, active control of blood sugar and correction of renal failure should be done.

　　4. When the range of gangrene is wide, it affects the lower abdominal wall, and the scar contraction of the wound surface is necessary to plant skin.

　　5. Hyperbaric oxygen therapy In recent years, some people believe that hyperbaric oxygen therapy should be adopted for anaerobic bacteria, but the efficacy is still lacking in comparison.

　　II. Prognosis

　　Phlegmonous necrosis of the scrotum can occur at any age, with an acute onset and rapid progression. If diagnosed in time (within 12 hours of onset), active treatment can reduce the lesion and heal quickly; if diagnosis and treatment are not made until 24 hours after onset, it is often difficult to stop further necrosis by reducing the tension of the scrotal incision, which can invade the tunica vaginalis of the testicle, expose the testicle, and even affect the penis and abdominal wall, becoming a severe lesion. Therefore, early diagnosis and timely treatment are emphasized for this disease, and comprehensive treatment measures for the whole body and locally are the key to curing this disease.