The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

Chana A. Sacks, M.D., Editor

Fournier’s Gangrene
A B

Chih-Sheng Huang, M.D.
National Yang-Ming University Hospital
Yilan City, Taiwan
imalive20@hotmail.com
A
46-year-old man with uncontrolled type 2 diabetes and alco-
holic liver disease presented to the emergency department with painful
swelling in the scrotum and perianal region. His temperature was 37.7°C,
his pulse 130 beats per minute, and his blood pressure 97/61 mm Hg. The physical
examination was notable for necrotic-appearing tissue in the scrotum and perineum,
with areas of induration and crepitus (Panel A). Computed tomography revealed
subcutaneous emphysema in the scrotum and perianal fascia, in addition to air in
the pararectal fascia and rectal wall (Panel B, arrow). A diagnosis of Fournier’s
gangrene, or necrotizing fasciitis of the perineum, was made. Fournier’s gangrene
is a rare, life-threatening, fulminant infection. Elderly men and men with diabetes
and chronic alcohol-use disorder are at increased risk. The patient underwent
prompt laparoscopic-assisted abdominal perineal resection. Pathological analysis
revealed multiple gas-filled pockets in necrotic tissue, with neutrophilic infiltration.
In addition to surgery, the patient received fluid resuscitation and broad-spectrum
antibiotics. Approximately 3 weeks after surgery, split-thickness skin grafting was
performed for perineum reconstruction. The patient was discharged home with a
permanent colostomy.
DOI: 10.1056/NEJMicm1609306
Copyright © 2017 Massachusetts Medical Society.

1158 n engl j med 376;12 nejm.org March 23, 2017

The New England Journal of Medicine

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