フォーニエ症候群：外科手術と人間関係によって命を救うことについての泌尿器科医の考察

最終更新日： 2026年8月15日

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It is a profound honour to share this reflection. Looking back at the 第26回カンボジア外科学会学術大会, 、開催された 2021年2月6日, I recognise it as a pivotal milestone in my career. Serving as the speaker for the Cambodian Urology Society while representing the Urology Department of Royal Phnom Penh Hospital was not just a professional duty — it was a chance to share lessons learned from the front line of surgical emergencies.

Today I want to walk through a case that tested every part of my clinical skill and the foundation of the doctor-patient relationship. This is a reflection on managing Fournier’s gangrene — a life-threatening urological emergency — during the height of the COVID-19 pandemic, while I was practising urology in Cambodia.

フォーリエル坏疽とは何ですか？

フランスの皮膚科医にちなんで名付けられた アルフレッド・フォ-ルニエ博士, 、この状態は一種の necrotising fasciitis affecting the genital and perineal area. It is a true surgical emergency — every hour of delay matters.

病気は 多菌性の, 、したがって、有酸素菌と嫌気性菌の両方を組み合わせたものになります。たとえば、 大腸菌 そして 緑膿菌 — working together to destroy soft tissue at an alarming rate. It often begins subtly: a urinary tract infection, a small perineal abscess, or a minor genital procedure. Once it takes hold of the fascia, the layer of tissue beneath the skin, it spreads rapidly.

早期発見が命を救う理由

Reported mortality varies widely between published series — older reports describe figures above half of all patients, while modern series with early surgery and intensive care report considerably lower rates. That spread is itself the point. The single variable that moves it most is time from onset to the operating theatre, which is one of the few things a patient can influence directly by seeking help early. Outcome also depends on age, the extent of tissue involvement, and how unwell the patient is on arrival.

だから early diagnosis is the key to survival. The window between a small painful area and a life-threatening emergency can be measured in hours rather than days.

誰がリスクにありますか？

Certain conditions make people significantly more vulnerable. The most important risk factors include:

• 未治療または未診断の糖尿病 — 最も一般的な単一のリスク要因。.
• 大量飲酒 — 免疫系を弱め、栄養状態を損なう.
• 免疫抑制 — 慢性疾患、化学療法、HIV、または長期間のステロイド使用によるもの。.
• 栄養失調 低血清アルブミン値に反映される。.
• 最近の会陰部手術、肛門周囲膿瘍、または未治療の尿路感染症。.

Two things that are commonly missed, and both matter.

It is not only a men’s disease. Fournier’s gangrene is far more common in men, which is why it is usually discussed in a urological setting, but women and occasionally children develop it too. A woman with rapidly worsening perineal or vulval pain out of proportion to what can be seen should be taken exactly as seriously.

SGLT2 inhibitors carry a specific warning. This class of diabetes medicine — the drugs whose names end in -gliflozin, such as dapagliflozin, empagliflozin and canagliflozin — has been the subject of a regulatory safety warning about a rare association with Fournier’s gangrene. These are valuable drugs with real cardiovascular and kidney benefits, and the risk is small. Do not stop taking one because you have read this. What is worth doing is knowing the warning signs below, and seeking care urgently rather than waiting if genital or perineal pain, swelling or redness develops while you are on one.

決して見過ごしてはならない警告サイン

One of the most dangerous features of Fournier’s gangrene is that early symptoms can resemble a simple infection or abscess — but the disease behaves entirely differently. The following table is intended as a patient-safety guide:

一般的な感染症	危険信号
局所的な患部の痛み	急速に広がる痛み 元の領域を超えて、しばしば皮膚に見えるもの disproportionate
軽度の発赤と腫れ	肌がくすんだり、黒ずんだり、まだらになったりする, or develops blisters or a foul odour
パラセタモールでコントロール可能な痛み	一般的な鎮痛剤でコントロールできないほどの重度の痛み
微熱、全体的に良好	混乱、頻脈、低血圧、または劇的な体調不良 敗血症の兆候
経口抗生物質で症状が改善	抗生物質を使用しても症状が悪化しています, 特に糖尿病やアルコール使用のある方の場合

If you or someone you know experiences any of these red-flag signs, go to the nearest emergency department immediately — not to a clinic appointment, and not to a message. Fournier’s gangrene is one of the few conditions in urology where the difference between life and death is measured in hours.

患者さんの物語 — 最前線からの教訓

The account that follows is drawn from cases I managed during my years in urology. Identifying details have been changed or combined, and it is presented for what it teaches rather than as a record of any one person.

A man reached our department after several days of worsening perineal pain. He had been treated elsewhere for what was thought to be a simple perianal abscess, with oral antibiotics and ordinary pain relief. By the time he arrived the pain was unbearable, the skin was changing colour, and the tests showed what neither he nor the doctors before us had known: the familiar and dangerous combination of uncontrolled diabetes, heavy alcohol use and poor nutrition. Imaging confirmed Fournier’s gangrene. Circumstances at the time made transfer elsewhere impractical, and the cost of treatment was a real burden for him — both of which shaped everything that followed.

外科医のジレンマ — 信頼が治療になるとき

Understandably, the patient was frightened and angry. He was dissatisfied with our inability to give him an exact timeline for recovery or a fixed final cost. At his lowest point he refused to speak with the urology team at all.

I realised that to save his life, I first had to repair our relationship. So I changed approach:

1. Rebuild the bond. I moved from being a provider of a service to being someone he could trust through the hardest weeks of his life.
2. Personal care. 毎日、2回、自分でベッドサイドで創部処置を行いました。.
3. 共通点. We talked about things he cared about — politics, the economy — and let those conversations carry us through the medical work.

手術という戦い — 短距離走ではなくマラソン

Treating Fournier’s gangrene is rarely a single operation. It is a marathon of 段階的デブリードマン（外科的処置）, where the surgeon returns to theatre repeatedly to remove infected tissue until only healthy tissue remains. Each return allows the team to reassess what is alive, what is recovering, and what must still be removed. It is worth being honest that this can mean losing a significant amount of tissue, and that reconstruction afterwards is part of the plan rather than an afterthought.

外科手術と並行して、次の3つのことが進められました：

• 抗生物質 broad-spectrum coverage first, narrowed to targeted therapy once tissue cultures identified the responsible organisms.
• 学際的なチームワーク internal medicine colleagues brought his blood sugar under tight control, and the nursing team led meticulous wound care.
• 再建 once the infection was defeated, reconstructive surgery closed the wound and restored form and function.

回復と振り返り

By the time he left hospital, he was pleased with his outcome. Today he is doing well: his diabetes is controlled, his wound has healed, and he has returned to ordinary daily life.

What stayed with me is not the surgery. It is that the turning point came when the relationship was repaired — a quiet reminder that while an operation repairs the body, it is trust that carries the person through the weeks afterwards.

持ち帰りメッセージ

• 基礎が重要です。. Sound clinical practice and basic surgical skill are the foundation of every good outcome.
• The team wins it. Surgery, internal medicine, nursing and nutrition together — not the surgeon alone.
• The relationship is part of the treatment. The ability to connect with a frightened patient can matter as much as the scalpel.
• And for the reader, the only one that really counts: pain in the genital or perineal area that is spreading, disproportionate, or accompanied by feeling seriously unwell is an emergency — particularly with diabetes, heavy alcohol use or a suppressed immune system.

If you notice any of the red-flag signs above — especially if you have diabetes, are immunosuppressed, or take an SGLT2 inhibitor — do not wait, and do not message anyone for advice. Go to the nearest emergency department.

For non-urgent urological concerns or follow-up, Dr. Soarawee Weerasopone consults at バンコク病院本部 and at Samitivej Sriracha Hospital, Chonburi — 088-022-1445. The wider range of conditions covered is set out under 泌尿器科.

Bangkok Hospital Telemedicine is available for non-urgent matters, including for international patients — arrange it in advance by email to the Urology department at bhquro@bdms.co.th. It is not appropriate for anything described on this page as a red flag: that needs an emergency department, in person, now. Samitivej Sriracha is in-person only.

フォーニエ壊疽に関するよくある質問

フォニエール病とは、陰嚢や陰茎、会陰部などが急速に壊死していく、まれで重篤な感染症のことです。

Fournier’s gangrene is a rare but life-threatening bacterial infection of the soft tissues of the genital and perineal area. It is a form of necrotising fasciitis, meaning the infection rapidly destroys the deep tissue layer beneath the skin and can lead to sepsis and death if not treated urgently with surgery and antibiotics.

フォーニエ壊疽の最もリスクが高いのは誰ですか？

The most important risk factor is uncontrolled or undiagnosed diabetes mellitus. Others include heavy alcohol use, immunosuppression from HIV, chemotherapy or long-term steroids, severe malnutrition, and recent perineal infections, abscesses or procedures. It is far more common in men, but women and occasionally children are affected too.

Do SGLT2 inhibitors cause Fournier’s gangrene?

This class of diabetes medicine — the drugs ending in -gliflozin — has been the subject of a regulatory safety warning about a rare association with Fournier’s gangrene. The risk is small and these drugs have important cardiovascular and kidney benefits, so nobody should stop one on the basis of an article. What matters is awareness: if genital or perineal pain, swelling or redness develops while taking one, seek urgent assessment rather than waiting, and tell the doctor which medicines you are on.

フォーニエ壊疽の初期兆候は何ですか？

Pain in the genital or perianal area that spreads quickly and feels disproportionate to what is visible on the skin, dusky or darkening skin, foul odour, severe pain not controlled by ordinary painkillers, and signs of sepsis such as confusion, rapid heartbeat or low blood pressure. Symptoms worsening despite oral antibiotics is another warning. Any of these need emergency assessment.

フォーリャー症候群の治療法はどのようなものですか？

Three things working together: emergency surgical debridement, often in several stages, to remove infected tissue; broad-spectrum intravenous antibiotics narrowed once cultures identify the bacteria; and aggressive support of underlying problems such as diabetes and nutrition. Once the infection is controlled, reconstructive surgery closes the wound. Significant tissue may be lost in the process, which is part of why speed matters so much.

Fournier壊疽は治癒しますか？

Yes, with rapid recognition and aggressive treatment. With early surgery, modern antibiotics, intensive care and good control of underlying conditions, many patients recover fully. Mortality remains significant across published series, and the strongest determinant is how quickly the patient reaches an operating theatre — which is why the warning signs matter more than any other part of this article.

免責事項 This content is written and reviewed by Dr. Soarawee Weerasopone, a board-certified urologist at Bangkok Hospital Headquarters. It is intended for educational purposes only and does not constitute medical advice. Patient details in this article have been generalised to protect privacy. No advice, diagnosis or prescription is given through personal messaging channels or social media — and a suspected necrotising infection is not something to ask about by message. If you suspect a serious infection, go to an emergency department immediately.