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Fournier gangrene secondary to perianal abscess

Case contributed by Henry Knipe
Diagnosis almost certain

Presentation

Perineal pain and sepsis.

Patient Data

Age: 50 years
Gender: Male

Left perineal fat stranding and subcutaneous gas. Large gas and fluid collection within the posterior aspect of the left perineum with extension into the left ischioanal fossa. The collection is perianal in location, lying immediately left posterolateral to the anal canal with small locules of gas between the collection and posterior (6 o'clock) wall of the anal canal. Left laterally fat stranding extends into the subcutaneous tissues of the gluteal region. Fat stranding gas tracks into the anterior aspect of the left perineum. There is no inferior extension into the upper thighs. No supralevator extension.

Case Discussion

The patient proceeded to theater for drainage of the abscess, however no perianal fistula was identified. He made an uneventful recovery. When Fournier gangrene is suspected, lengthening the field of view to include to the mid-thigh (or lower based on clinical findings) is prudent to assess the full extent of infection. 

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