Septic shock due to Fournier’s gangrene of the scrotum

A 57-year-old morbidly obese (160 kg) man presented with a 12 h history of severe bilateral scrotal pain and swelling. His scrotum was erythematous, with cellulitis advancing superiorly along the anterior abdominal wall. He was in septic shock. Following resuscitation with intravenous fluids, commen...

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Bibliographic Details
Published in:BMJ case reports 2011-10, Vol.2011 (oct20 1), p.bcr0820114634-bcr0820114634
Main Authors: Callaghan, Michael Andrew, Baggott, Richard, D’Arcy, Frank T
Format: Article
Language:English
Subjects:
Alcohol
Anti-Infective Agents - therapeutic use
Antimicrobial agents
Colostomy
Debridement
Europe (East)
Fournier Gangrene - complications
Fournier Gangrene - surgery
Gangrene
Humans
Intensive care
Male
Microorganisms
Middle Aged
Ostomy
Other Full Case
Pain
Penis - surgery
Postoperative period
Reconstructive Surgical Procedures
Respiratory distress syndrome
Scrotum - surgery
Sepsis
Shock, Septic - etiology
Shock, Septic - therapy
Skin
Skin Transplantation
Staphylococcus infections
Surgical Flaps
White
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Summary:A 57-year-old morbidly obese (160 kg) man presented with a 12 h history of severe bilateral scrotal pain and swelling. His scrotum was erythematous, with cellulitis advancing superiorly along the anterior abdominal wall. He was in septic shock. Following resuscitation with intravenous fluids, commencement of vasopressor infusion and broad-spectrum antimicrobials, he underwent surgical exploration and debridement. This revealed a devitalised gangrenous scrotum with abscess formation noted in the ischio-rectal spaces. This was debrided posteriorly to the wall of the rectum. The penis was de-gloved. Both testicles were spared. A colostomy was performed on day 3 to maintain a clean environment for healing. Subsequent scrotal reconstruction and grafting was performed with a pedicled gracilis flap and split skin grafting. The colostomy was reversed at 5 months.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.08.2011.4634