Fournier's gangrene of the scrotum. A poorly defined syndrome or a misnomer?

Fournier's gangrene is defined classically as a fulminant, rapidly spreading infection of the scrotum that also involves the perineum, penis, and abdominal wall. The pathologic findings are described as synergistic gangrene secondary to a polymicrobial flora with a poorly defined portal of entry. In our experience with 12 cases, the portal of entry was well defined and the causative organisms were those typically found in the lower bowel. Portals of entry were perirectal abscesses in five patients, urethral infections in three, and surgical procedures in four patients. All patients required aggressive surgical debridement, broad-spectrum antibiotics, and adjunctive measures. The fact that four patients died in spite of aggressive treatment demonstrates the lethal nature of this disease. This study suggests that this syndrome is no longer "idiopathic" but is primarily a necrotizing cellulitis of the perineum with subsequent involvement of the genitalia and surrounding tissues.