Fournier Gangrene and Retroperitoneal Abscess Secondary to Perforated Appendicitis: A Case Report

Abstract

Fournier's gangrene and retroperitoneal abscess are rare complications of late presentation of perforated acute appendicitis. This case report discusses the case of a 46-year-old male patient who presented with 5 days history of progressive abdominal pain and was admitted to our department as a case of complicated perforated acute appendicitis followed by retroperitoneal abscess formation and Fournier's Gangrene few days later. The patient had a hospital stay of 53 days, during which he underwent diagnostic laparoscopy and appendectomy, computerized tomography guided percutaneous abscess incision and drainage for the retroperitoneal abscess and multiple scrotal debridement surgeries for the Fournier's gangrene, in addition to the drain care and intravenous antibiotic course he received. Diabetes mellitus is one of the most common risk factors of Fournier's gangrene, which was newly detected in our patient six months earlier. Fournier's gangrene is ten times more common in males than in females, especially in their third and sixth decade of life. It is life-threatening and has unfavorable prognosis that indicates early detection and aggressive surgical and medical intervention with a multidisciplinary approach, including fluid resuscitation, immediate initiation of broad-spectrum antibiotics and aggressive debridement of the necrotic tissue; in addition to the respiratory and hemodynamic support to improve the prognosis and overall outcome and to maximize the chances of survival.