Successful treatment following early recognition of a case of Fournier's scrotal gangrene after a perianal abscess debridement: a case report.J Med Case Rep. 2018 Jun 27; 12(1):193.JM
Fournier's gangrene is an acute surgical emergency characterized by high mortality rates ranging from approximately 13% to 45%. Therefore, aggressive multidisciplinary management is necessary.
A 29-year-old Asian man who had undergone surgical debridement at another hospital to treat a perianal abscess 5 days earlier was admitted to our hospital for severe scrotal and perianal pain, swelling, and high fever. A physical examination revealed a perianal abscess. Furthermore, the scrotum was gangrenous and exhibited extensive cellulitis in the perineum and bilateral inguinal area. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier's gangrene was made. The patient was treated with immediate surgical debridement under general anesthesia. He received broad-spectrum antibiotics, and debridement was repeated until the wound exhibited healthy granulation. Because both testes were severely exposed, they were transpositioned back into the scrotum 1 week after surgery. The patient was discharged on the 11th postoperative day.
The mainstay of treatment for Fournier's gangrene should include fluid resuscitation, broad-spectrum antibiotic therapy, intensive care, nutritional support, and early aggressive surgical debridement of all necrotic tissue.