AB176. Gastrointestinal causes for the acute scrotum
General Posters

AB176. Gastrointestinal causes for the acute scrotum

Emma Catherine Roche, Shane Considine, Frank D’Arcy

Department of Urology, University Hospital Galway, Galway, Ireland

Background: Fournier’s gangrene (FG) is a necrotizing fasciitis of the scrotum and perineum. It carries a high morbidity and mortality rate. It can occur secondary to a breach in urethral or gastrointestinal mucosal integrity. This case series highlights FG cases occurring secondary to gastrointestinal pathology.

Methods: A retrospective chart review of clinically diagnosed FG presentations to a single tertiary centre within a 2-year timeframe was performed. Corresponding gastrointestinal pathologies were identified. Fournier's Gangrene Severity Index (FGSI) scores were calculated retrospectively. Operative intervention and subsequent histology was reviewed.

Results: All patents were male. Age ranged 22–84 years. Significant comorbidities included diabetes and obesity. Presenting complaints included melaena (n=1), trauma (n=1) and testicular pain/unresolving epididymo-orchitis (n=2). Pyrexia and raised inflammatory markers noted in all cases. FGSI score >9 in two cases. Exploration/debridement performed in all cases. Inguinoscrotal hernia identified in two cases. Orchidectomy performed in three cases. Final histology: necrotic left testis and hernia sac containing large ulcerating colonic tumour with perforation [pT4aN1a(1/9)R0] (n=1), hernia sac containing perforated appendix and right peritesticular coagulative necrosis (n=1), necrotic inflammatory fasciitis (left testis) with post-operative diagnosis of colo-vesical fistula secondary to diverticular disease (n=1) and gangrenous scrotum with significant haemorrhage, inflammation and necrosis (n=1). Three patients discharged home well. One mortality.

Conclusions: FG is a severe and rapidly progressive condition. This series demonstrates an association with gastrointestinal pathology. Calculation of FGSI score can aid severity assessment. Significant morbidity and mortality rates exist, thus a high index of suspicion is required to ensure early diagnosis, prompt surgical intervention and multidisciplinary team involvement.

Keywords: Fournier’s gangrene; Fournier’s gangrene severity index; necrotising fasciitis; sepsis; mortality

doi: 10.21037/map.2020.AB176
Cite this abstract as: Roche EC, Considine S, D’Arcy F. Gastrointestinal causes for the acute scrotum. Mesentery Peritoneum 2020;4:AB176.