Fournier's gangrene of the scrotum. A poorly defined syndrome or a misnomer?
R. C. Lamb and G. L. Juler
Fournier's gangrene is defined classically as a fulminant, rapidly
spreading infection of the scrotum that also involves the perineum, penis,
and abdominal wall. The pathologic findings are described as synergistic
gangrene secondary to a polymicrobial flora with a poorly defined portal of
entry. In our experience with 12 cases, the portal of entry was well
defined and the causative organisms were those typically found in the lower
bowel. Portals of entry were perirectal abscesses in five patients,
urethral infections in three, and surgical procedures in four patients. All
patients required aggressive surgical debridement, broad-spectrum
antibiotics, and adjunctive measures. The fact that four patients died in
spite of aggressive treatment demonstrates the lethal nature of this
disease. This study suggests that this syndrome is no longer "idiopathic"
but is primarily a necrotizing cellulitis of the perineum with subsequent
involvement of the genitalia and surrounding tissues.
