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Fournier's gangrene

Nature Clinical Practice Urology volume 3, pages 54–57 (2006)Cite this article

Abstract

Background A 59-year-old man presented with a 4-day history of scrotal pain and swelling and the rapid development of moist, black, foul-smelling lesions on the scrotum and penis. As a liver-transplant recipient, he was immunosuppressed. He also had type 1 (insulin-dependent) diabetes and poor nutrition, which might have compromised immunity further.

Investigations Physical examination, blood and tissue cultures, full blood count, urea and electrolytes, liver function tests, coagulation profile, C-reactive protein, and examination under anesthesia.

Diagnosis Fournier's gangrene originating from an infected cutaneous lesion in an immunocompromised patient.

Management Resuscitation and triple broad-spectrum antibiotics, urgent surgical debridement, serial examinations under anesthesia with further debridements, and split-skin grafting. Phallic reconstruction is planned.

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Figure 1: Photograph of patient's scrotum showing scrotal wall edema and skin discoloration.
Figure 2: Photograph of patient's penis and scrotum showing almost circumferential distal penile skin involvement.
Figure 3: Appearance of patient's pubic region after initial debridement, with scrotum and suprapubic fat pad excised, testes preserved within tunica vaginalis, and penile skin and subcutaneous tissue debrided.
Figure 4: Photograph of patient's pubic region after initial debridement, with testes displaced to show the extent of the perineal wound.

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Author information

Authors and Affiliations

  1. Addenbrooke's Hospital, Cambridge

    Tevita 'Aho

  2. Hinchingbrooke Hospital, Huntingdon, UK

    Tevita 'Aho

  3. Addenbrooke's Hospital, Cambridge

    Alessandra Canal

  4. West Suffolk Hospital, Bury St Edmunds, Suffolk, UK

    Alessandra Canal

  5. Cambridge University,

    David E Neal

  6. Department of Urology at Addenbrooke's Hospital, Cambridge, UK

    David E Neal

Authors
  1. Tevita 'Aho
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  2. Alessandra Canal
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  3. David E Neal
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Corresponding author

Correspondence to Tevita 'Aho.

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The authors declare no competing financial interests.

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'Aho, T., Canal, A. & Neal, D. Fournier's gangrene. Nat Rev Urol 3, 54–57 (2006). https://doi.org/10.1038/ncpuro0353

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