Bob, a 47-year-old chronic alcoholic with no history of routine health care, presented to the emergency room of a small rural hospital complaining of scrotal discomfort. He had zipped the base of his penis in his jeans 2 days prior, and although he denied fever, chills, urethral discharge, dysuria, or any other voiding symptoms, the pain had worsened to the point where he could no longer tolerate it.
On examination, a small abrasion on the left base of his penis was discernable. The abrasion measured approximately 0.5 cm in length with no associated edema, erythema, or ecchymosis. In spite of minimal physical findings, Bob was admitted for overnight observation because of his pain level. Blood work was obtained and antibiotic therapy with intravenous (IV) LevaquinAE (levofloxacin) 500 mg daily and AncefAE (cefazolin) 1 Gm every 6 hours was initiated. Initial laboratory results revealed a white blood cell (WBC) count of 14.95 with a shift to the left, platelet count of 148,000, and electrolytes essentially normal except for the potassium being slightly de creased at 3.3. As the night proceeded, Bob's nurse recorded development of significant edema and erythema involving the penis and scrotum. Upon examination in the morning, severe penile and scrotal edema was noted, along with erythema to the level of the symphysis pubis. The overlying skin was weeping, dark purple in color, with evident bullae. At this point, Bob, being completely pain free, requested to be discharged home. Although stat blood work results from early morning showed a drop in the WBC to 11.69, normal electrolytes, and only a mild drop in platelets to 135,000, necrotizing fasciitis was suspected. This diagnosis was explained to Bob and his family, stressing the importance of emergent surgical treatment. Metronidazole 500 mg IV was immediately administered, and arrangements were made to transfer the patient to a nearby teaching hospital. Upon transfer, Bob underwent urgent wide debridement of the gangrenous tissue requiring complete removal of the scrotal wall, bilateral appendix testes, and infrapubic skin. In addition, penile degloving and implantation of the testicles into skin pockets in the medial thighs were performed. Bob made a full recovery, opting not to undergo scrotal reconstruction. Although Bob has not returned for followup, his family relates that he is doing well with no residual voiding or erectile difficulties.
Urol Nurs. 2007;27(4):296-299. © 2007 Society of Urologic Nurses and Associates
Cite this: A Case of Fournier's Gangrene - Medscape - Aug 01, 2007.