Fink Benjamin A, Son Young, Thomas Brian, Mueller Thomas J, Berkman Douglas S
Urology, Rowan University, School of Osteopathic Medicine, Stratford, USA.
Urology, Jefferson Stratford Hospital, Stratford, USA.
Cureus. 2022 Jan 25;14(1):e21612. doi: 10.7759/cureus.21612. eCollection 2022 Jan.
Fournier's gangrene and emphysematous pyelonephritis are rare necrotizing infections of the genitourinary system. Many cases of this rapidly progressive infection occur from abscesses and urinary tract infections; however, Fournier's gangrene secondary to emphysematous pyelonephritis is seldom discussed in the literature. Emphysematous pyelonephritis is defined as a gas-forming, necrotizing infection of the renal parenchyma or its surrounding tissue. Emphysematous pyelonephritis has been observed in high-risk individuals, including those with poor glycemic control and urinary tract obstruction. We present a 61-year-old male with emphysematous pyelonephritis arising from a perinephric hematoma with tracking of the infection to the scrotum, resulting in Fournier's gangrene. The perinephric hematoma most likely developed from increased intrarenal hydrostatic pressure during nephroureteral stent placement. Broad-spectrum antibiotic therapy and surgical debridement of the retroperitoneum, groin, and scrotum were performed ultimately requiring left orchiectomy. We conclude that an existing hematoma can precipitate emphysematous pyelonephritis with tracking from the retroperitoneum to scrotum, causing Fournier's gangrene. High-risk patients with perinephric hematomas can be susceptible to this pathologic transformation.
福尼尔坏疽和气肿性肾盂肾炎是泌尿生殖系统罕见的坏死性感染。这种快速进展性感染的许多病例源于脓肿和尿路感染；然而，文献中很少讨论气肿性肾盂肾炎继发的福尼尔坏疽。气肿性肾盂肾炎被定义为肾实质或其周围组织的产气性坏死性感染。气肿性肾盂肾炎已在高危个体中观察到，包括血糖控制不佳和尿路梗阻的患者。我们报告一例61岁男性，因肾周血肿并发气肿性肾盂肾炎，感染蔓延至阴囊，导致福尼尔坏疽。肾周血肿很可能是在放置输尿管支架期间肾内静水压力增加所致。最终进行了广谱抗生素治疗以及腹膜后、腹股沟和阴囊的手术清创，患者最终需要行左侧睾丸切除术。我们得出结论，现有的血肿可促使气肿性肾盂肾炎发生，并从腹膜后蔓延至阴囊，导致福尼尔坏疽。有肾周血肿的高危患者可能易发生这种病理转变。
