Rahmatika Nadya, Wirjopranoto Soetojo, Soetojo Bagus Wibowo, Azmi Yufi Aulia, Putra Antonius Galih Pranesdha, Soetanto Kevin Muliawan
Departement of Pediatric, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
Department of Urology, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
Int J Surg Case Rep. 2025 Oct;135:111888. doi: 10.1016/j.ijscr.2025.111888. Epub 2025 Sep 4.
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.
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.
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.
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.
老年是与福尼尔坏疽（FG）死亡率相关的危险因素之一。当存在这种风险且诊断过晚时，患者护理可能会变得困难。本病例报告讨论了一名老年患者晚期诊断为福尼尔坏疽的治疗情况及其在此背景下的后果。
一名65岁男性被紧急转诊至急诊科。一周来，患者的主要症状是间歇性高热，并伴有间歇性阴囊疼痛加剧。肾脏、输尿管和膀胱（KUB）的X线检查显示盆腔区域有气体积聚和软组织水肿。使用速效胰岛素控制血糖水平，并进行经验性抗生素注射用于初始治疗。在左腹股沟区发现了一个窦道，立即进行了清创，从坏死区域切开开始。每天常规进行伤口护理。总体而言，患者情况良好。
本病例强调了基于KUB X线的影像学评估来诊断福尼尔坏疽的重要性。在本病例中，KUB有助于确诊气性坏疽，因为患者急性阴囊肿胀5天，晚期才被诊断为FG。最初的体格检查未发现捻发音或坏死区域。FG是一种临床诊断，影像学检查不应延误源头控制。清创坏死切除术是最后一步，必须迅速并同时采取药物和非药物措施。如果存在2型糖尿病，药物措施包括控制血糖和给予双重经验性抗生素。
如果老年患者报告阴囊和睾丸疼痛，建议进行全面的体格检查，包括各项检查。如果发现问题过晚，将同时积极进行药物和非药物治疗。
