Management on late diagnosed Fournier's gangrene in elderly patient and it's complication: A case reports

Introduction and importance

One of the risk factors linked to mortality in Fournier Gangrene (FG) is the elderly. When this risk is present and diagnosed too late, patient care may become difficult. This case report discusses the treatment of an older patient with late-diagnosed Fournier's gangrene and its consequences in this background.

Case presentation

An emergency department (ER) referral was made for a 65-year-old male. For one week, the patient's main complaint was a sporadic high fever that got worse along with sporadic scrotal soreness. An X-ray of the kidney, ureter, and bladder (KUB) revealed gas accumulation and soft tissue oedema in the pelvic region. Fast-acting insulin was used to control blood sugar levels, and empirical antibiotic injections were used for initial care. A tunnel was discovered in the left inguinal area, and debridement was carried out right away, beginning with an incision in the necrotic area. Daily wound care was done routinely. Overall, the patient was doing well.

Clinical discussion

This case highlights how crucial it is to diagnose Fournier's gangrene based on the radiological evaluation of a KUB X-ray. In this case, the KUB helped confirm gas gangrene because the patient had experienced acute scrotal swelling for 5 days, which was diagnosed late as FG. The initial physical examination revealed no crepitus or necrotic areas. FG is a clinical diagnosis, and imaging should not delay source control. Debridement necrotomy is the final step, and pharmacological and non-pharmacological measures must be taken promptly and concurrently. If type 2 diabetes mellitus is present, pharmacological measures include blood sugar control and the administration of double empirical antibiotics.

Conclusion

An extensive physical examination, including investigations, is advised if an aged patient reports scrotal and testicular pain. Aggressive pharmaceutical and non-pharmacological treatment will be administered concurrently if the problem is discovered too late.