Teaching Case

54 year- old male with extensive edema and subcutaneous emphysema of scrotum, penis and lower abdomen. Ultrasound and CT revealed scrotal and lower abdominal soft tissue air and edema.

The patient was admitted to our hospital with extensive edema and subcutaneous emphysema of the scrotum, penis and lower anterior abdominal wall. The duration of symptoms before admission was 7 days. Physical examination revealed also a longstanding perianal fistula. The patient had elevated serum glucose levels (>200 mg/dl) with no known previous history of diabetes mellitus, leukocytosis (WBC 29.000) and normal serum creatinine. We performed scrotal ultrasound (figure 1), a plain abdominal radiography (figure 2) and CT (figures 3 and 4).

Fournier΄s Gangrene (FG) is an acute severe necrotizing infection affecting scrotum, penis and perineum. Genitourinary and colorectal pathology like perianal abscess / fissure, urethral stricture, urinary tract iatrogenic trauma are common etiologies of this infection. Usually FG involves both aerobic and anaerobic infecting microorganisms. Age > 70 yrs and evidence of renal dysfunction are poor prognostic criteria despite agressive therapy. Diagnosis is based on clinical examination and imaging findings (Ultrasound, CT). Patients are treated with broad spectrum antibiotics along with frequent and extensive surgical debridements and supportive care ( potential use of hyperbaric oxygen ).