Fournier gangrene

Case contributed by Hein Els


Diabetic with 5 day history of induration of the left perineum and inguinal region.

Patient Data

Age: 60
Gender: Female

Fat stranding and soft tissue emphysema of the left side of the perineum, left side of the vulva extending into the left ishioanal and ishiorectal fossae, left inguinal region and along the left anterolateral abdominal wall to the left upper quadrant (up to the level of L2 vertebral body). Rim enhancing collections in the left lower gluteal area, left ishiorectal fossa. No supra-levator extension or retroperitoneal involvement. 

Right adrenal lesion (5.6cm) with soft tissue and fat attenuation. No signs of a retroperitoneal hemorrhage. 

Large lower abdominal wall hernia containing small bowel and a segment of transverse colon. No signs of bowel obstruction or incarceration. Two other ventral hernias containing fat. 

Case Discussion

Fournier gangrene is a surgical emergency with a mortality rate of approximately 33%. Imaging with CT is usually not required for diagnostic purposes, but to determine the extent of the disease, especially for retroperitoneal involvement. 

The adrenal lesion is most compatible with an adrenal myelolipoma. The lesion measures in excess of 4cm and is therefore at risk for spontaneous retroperitoneal hemorrhage. 

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