Presentation
Swelling and erythema in left groin and scrotum in a diabetic patient. Patient complains of local pain that started one day earlier and a maximum systemic temperature of 38.5°C.
Patient Data
Limited study due to patient unrest - complains of pain and exquisite tenderness.
Thickened scrotum.
Small left inguinal hernia with large amount of gas in the soft tissues.
Normal-appearing testes.
Left testicular and epididymal hyperemia, probably reactive.
Small intersphincteric perianal fistula with several small gas locules.
Gas in the subcutaneous fat along the perineum on the left, and the left groin around an inguinal hernia, continuing into the left scrotal sac around the testis. Fat stranding and thickened skin in the groin, scrotum and perineum.
Incidental sigmoid colon diverticula.
Contrast-enhanced CT at the portal phase did not include most of the scrotum, so the radiologist requested a repeat CT (shown here). This accounts for the concentrated contrast material in the ureters and urinary bladder.
Case Discussion
The patient had urgent surgery.
The surgical report stated: Fournier gangrene - necrotizing fasciitis of perianal, perineal and left scrotal region.
Wide incision, drainage and necrosectomy:
A small perianal abscess was identified anterior to the anus, continuing along the subcutaneous fascia to the left hemiscrotum and groin, with soft tissue gas and gangrene. A wide excision was made on the left, beginning anterior to the anus and ending in the groin. The left testis was exposed and released. Wide debridement of necrotic tissue was performed, with identification and preservation of the urethra, spermatic cord and left testicular blood supply.
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