DR.MOHAMMED IRFAN SHEIKHover 5 years ago

Fournier’s Gangrene

A 46-year-old man with uncontrolled type 2 diabetes and alcoholic liver disease presented to the emergency department with painful swelling in the scrotum and perianal region. His temperature was 37.7°C, his pulse 130 beats per minute, and his blood pressure 97/61 mm Hg. The physical examination was notable for necrotic-appearing tissue in the scrotum and perineum, with areas of induration and crepitus (Panel A). Computed tomography revealed subcutaneous emphysema in the scrotum and perianal fascia, in addition to air in the pararectal fascia and rectal wall (Panel B, arrow). A diagnosis of Fournier’s gangrene, or necrotizing fasciitis of the perineum, was made. Fournier’s gangrene is a rare, life-threatening, fulminant infection. Elderly men and men with diabetes and chronic alcohol-use disorder are at increased risk. The patient underwent prompt laparoscopic-assisted abdominal perineal resection. Pathological analysis revealed multiple gas-filled pockets in necrotic tissue, with neutrophilic infiltration. In addition to surgery, the patient received fluid resuscitation and broad-spectrum antibiotics. Approximately 3 weeks after surgery, split-thickness skin grafting was performed for perineum reconstruction. The patient was discharged home with a permanent colostomy.