Fournier gangrene

Case contributed by Dr Michael P Hartung

Presentation

Diabetes and hypertension. Concern of perirectal abcess.

Patient Data

Age: 55 years
Gender: Male
CT

Numerous fine locules of mottled subcutaneous gas within the perineum, scrotum, about the right testicle, and ascending along the right spermatic cord. No organized fluid collections.

Diagnoses
Preoperative diagnosis: necrotizing soft tissue infection scrotum and perineum
Postoperative diagnosis: same

Operation
Operation: radical soft tissue debridement of skin: subcutaneous tissue and fascia of the scrotum perineum and left perianal region buttocks.

Indications
55-year-old gentleman with diabetes and hypertension presents with 3-day history of progressive soft tissue infection hernia perianal girdle area crepitations on examination consistent with necrotizing fasciitis.

Description
Patient was taken to the operating room and underwent satisfactory general anesthesia was positioned dorsal lithotomy. Timeout was taken by the surgical team identifying the proper patient and procedure to be performed. Perineum was prepped and draped in the usual sterile fashion to include the genitalia scrotum perineum buttocks and perianal. Skin soft tissue and fascia was excised including a portion of the scrotum perineum all the way to the margin portion of the grossly infected tissue was excised. Dishwater type fluid without much older was identified and cultures for aerobic anaerobes. Once all grossly infected necrotic tissue was excised was irrigated with a power irrigator 1 L saline. The wound was rendered hemostatic with electrocautery and packing with 4 x 4 gauze and Medipore tape fishnet panties.

Case Discussion

This is a classic appearance of necrotizing soft tissue infection of the scrotum, most common in diabetic patients. This is managed with aggressive surgical debridement, as in this case.

Culture results:
Enterococcus faecium - numerous growth
Streptococcus, viridans group - moderate growth

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Case information

rID: 60341
Published: 17th May 2018
Last edited: 14th Aug 2019
System: Urogenital
Inclusion in quiz mode: Included

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