Fournier's gangrene: still highly lethal.

Five patients with necrotizing soft tissue infections of the perineum and scrotum are presented. There were one female and four male patients, aged from 35 to 70 years. Portals of entry were perirectal abscesses in four cases and a scrotal abscess in one case. All patients required extensive surgical debridement and intravenous broad-spectrum antibiotics. Operative debridement involved the scrotum, the perineal and inguinal area, the upper thighs and the anterior abdominal wall. One patient required transverse loop colostomy and one loop sigmoidostomy. One patient was reoperated on after inadequate drainage of a perirectal abscess. Three patients were referred to our unit after some delay, while one patient did not seek medical care until after being febrile for 2 weeks. Despite aggressive debridement, this last patient died of fulminant sepsis. Fournier's gangrene, which is not so rare as in generally considered, is still associated with a high mortality, which can be reduced only by improving medical awareness and early treatment both of the primary cause and of necrotizing fasciitis.