Fournier's Gangrene: A Case of Neglected Symptoms with Devastating Physical Loss

Abstract

Fournier's gangrene is a severe life-threatening infection involving the perianal area, perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles' fascia around the external genitalia. It can extend cephalad to involve the Scarpa's fascia and Camper's fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications. We describe a case of a 58-years-old man presenting with Fournier's gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his loss and disfigurement.

Keywords: gangrene; genitalia; orchidectomy; perineum; psychology.

Figure 1:

1. (A) Gangrene and swelling of the external genitalia.

1. (B) Gangrenous corpus spongiosum and perineal necrosis.

1. (C) A stone removed from the membranous urethra.

1. (D) Penile and right testicular gangrene.