THE SCROTUM Fournier’s gangrene

THE SCROTUM Fournier’s gangrene

Fournier’s gangrene is an uncommon and nasty condition ( Figure 86.19 ) characterised by a polymicrobial infection of the soft tissues of the perineum, external genitalia and peri anal region. It is a form of necrotising fasciitis. There is rapid onset of gangrene leading to exposure of the scrotal contents. Although it can occur in conjunction with sepsis of the testis, epididymis or perianal region, an obvious cause is absent in over half the cases. It can arise following minor injuries or procedures in the perineal area, such as a bruise, scratch, urethral dilatation, injection of haemorrhoids or opening of a periurethral abscess. Many patients have concurrent illnesses that diminish their defences, most notably diabetes mellitus and alcoholism. There is a mixed infection of aerobic and anaerobic bacte ria in a fulminating inflammation of the subcutaneous tissues, which results in an obliterative arteritis of the arterioles to the Jean Alfred Fournier , 1832–1915, syphilologist, founder of the V enereal and Dermatological Clinic, Hôpital St Louis, Paris, France. can spread rapidly to involve the fascia and skin of the penis, perineum and abdominal wall.

Figure 86.19 Fournier’s gangrene with an area of necrotic skin overlying an area of scrotal in /f_l ammation.