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Case Reports
. 2011:2011:702429.
doi: 10.1155/2011/702429. Epub 2011 Jan 20.

Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

Ioannis Papaconstantinou  1 , Anneza I Yiallourou, Nicolaos Dafnios, Irini Grapsa, George Polymeneas, Dionysios Voros
Affiliations
Case Reports

Successful Treatment of a Severe Case of Fournier's Gangrene Complicating a Perianal Abscess

Ioannis Papaconstantinou et al. Case Rep Med. 2011.

Abstract

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier's gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

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Figures

Figure 1
Figure 1
Computed tomography of the pelvis dipecting extensive emphysema around the testicles and perineal subcutaneous tissue.
Figure 2
Figure 2
(a) Preoperative image showing considerable edema and scrotal necrosis. (b) Intraoperative image of the immediate surgical debridement demonstrating the extensive necrosis of the scrotum and perianal region.
Figure 3
Figure 3
Wide-open drainage of the necrotic skin in the scrotum and perineal area.
Figure 4
Figure 4
The left testicle is transpositioned into a subcutaneous pocket in the inner side of the left thigh.
Figure 5
Figure 5
Image of the surgical wound four weeks after the initial operation showing that the gas gangrene has completely resolved, the wide wound is reduced, and good granulation is present.
See this image and copyright information in PMC

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