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. 2014 Sep 24:7:37.
doi: 10.1186/s12245-014-0037-0. eCollection 2014.

Fournier's gangrene after adult male circumcision

Moses Galukande  1 , Dennis Bbaale Sekavuga  2 , Alex Muganzi  2 , Alex Coutinho  2
Affiliations

Fournier's gangrene after adult male circumcision

Moses Galukande et al. Int J Emerg Med. .

Abstract

Background: In the advent of mass voluntary medical male circumcision (VMMC) for the partial prevention of HIV, previously rare adverse events associated with adult male circumcision are likely to be encountered with higher frequency. Fournier's gangrene, defined as a polymicrobial necrotizing fasciitis of the perineal, perianal or genital areas, is one such rare and life-threatening adverse event. In this report, we present two cases that were identified in the context of a VMMC programme over a 3-year period during which approximately 100,000 adult circumcisions were performed.

Case presentations: Case 1: A 19-year-old male who had VMMC performed using the dorsal slit technique developed pain and blisters on the scrotal skin on the sixth postoperative day. He had no co-morbidities, and serology for HIV was negative. On examination, locally he had scrotal skin necrosis with an offensive odour and was dehydrated but afebrile. Repeated aggressive debridement was done while he stayed in a hospital for 3 weeks; at which point, he had healthy granulation tissue and was free of infection. The wound had closed spontaneously and completely by the fifth month. Case 2: A 52-year-old male who had VMMC performed with the sleeve resection method developed pain and swelling of the penis and scrotum on the fourth postoperative day. He had a low-grade fever of 37.6°C. He was not diabetic or immunosuppressed and had a negative HIV serology. He was admitted and was given IV antibiotics, and repeated aggressive debridement was performed. On the third week of hospitalization, he had healthy granulation tissue and received a split skin graft on the penile shaft. At 4 months, the scrotal defect had completely closed.

Conclusion: Fournier's gangrene is a rare occurrence after adult male circumcision with associated high morbidity. These are the first descriptions in the VMMC era.

Keywords: Adult; Circumcision; Gangrene; Male.

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Figures

Figure 1
Figure 1
A picture of case report 1 on day 8.
Figure 2
Figure 2
A picture of case report 1 on day 19.
Figure 3
Figure 3
A picture of case report 1 on week 7.
Figure 4
Figure 4
Shows a full healed wound after 5 months for case 1.
Figure 5
Figure 5
A picture of case report 2 on day 7.
Figure 6
Figure 6
A picture of case report 2. Penile split skin graft a week after grafting and a month from occurrence of event.
Figure 7
Figure 7
A picture of case report 2 after 3 months from time of event.
Figure 8
Figure 8
A picture of case report 2 when healed after 4 months.
See this image and copyright information in PMC

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