A  75  year  old  man  was  admitted  3  days  post  prostatectomy  with  a  febrile illness. Examination revealed lower abdominal tenderness and a clinical photograph of his groins and external genitalia is shown below.

a)  What is shown in this picture below?

b)  List 2 important management steps

[Click here to toggle visibility of the answers]

College Answer

a)  What is shown in this picture below?

Fournier’s gangrene.

b)  List 2 important management steps

Urgent surgical debridement
Use of meropenem  or other reasonable combinations

A clinical photograph of Fournier’s gangrene was supplied.

Discussion

The image above was stolen shamelessly from www.christem.com. No permission was asked for.

If they ask me to take it down, they do so with the knowledge that they have sent a very motivated man into the community with the explicit purpose of photographing genitals in early stages of decomposition. Cui bono?

One could get very clever about this condition, but the bottom line is simple. Surgical debridement is the only thing that saves lives in this condition. Broad spectrum antibiotics are of course mandatory, and meropenem is a good choice.

References

Eke, Ndubuisi. "Fournier's gangrene: a review of 1726 cases." British Journal of Surgery 87.6 (2000): 718-728.