Fournier gangrene with osteomyelitis

Case contributed by Dr Derek Smith

Presentation

Known IVDA. Pus discharging from right groin injection site. Is there an abscess or a pseudoaneurysm? Raised inflammatory markers (CRP 580, WCC 18).

Patient Data

Age: 30 years
Gender: Male

Sinus at the right groin with locules of gas but no drainable collection or pseudoaneurysm.

Concerning and complex appearances of the left side:

Scarred tract in the left groin; no pseudoaneurysm. Extensive gas and fluid containing collection involving left rectus abdominis muscle, public symphysis and left thigh adductor muscle compartment. Craniocaudal extent nearly 25 cm.

This extends further into the perineum along the left side of the penis (possible involvement of corpus spongiosum although the urethra is already catheterized).

Destruction and fragmentation of the left pubic bone, with a bone fragment displaced into the scrotum.

Case Discussion

Despite the clinical history, there was contralateral extensive necrotizing fasciitis with involvement of the perineum and pubic bone (Fournier gangrene and osteomyelitis). This case was a surgical emergency and the patient went straight to theater for debridement and orchiectomy.

There was mixed microbiology including E. coli and S. aureus infection.

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