A rare etiology of Fournier's gangrene

Abstract

The etiologies of Fournier's gangrene are well described into four groups: anorectal, genitourinary, dermatologic, and idiopathic. Here, we present the case of a hematoma and acute osteomyelitis (related to a closed fracture of the pubis), which progressed to Fournier's gangrene 1 month after trauma. A 68-year-old woman was admitted to our emergency department because she had sustained a left side pubic bone fracture from a fall. On her first admission to our emergency department, conservative treatment had been prescribed; however, she was readmitted to our emergency department due to septic shock, local swelling, and pus discharge from the pubis and the left labium majus. A whole abdomen computed tomography scan revealed fluid accumulation in the left suprapubic and perineum region in addition to acute osteomyelitis of the pubis. Acute osteomyelitis-related Fournier's gangrene and sepsis were suspected; hence, she underwent urgent fasciotomy and sequestrectomy. After three rounds of sequestrectomies, partial wound reconstruction with local flap and 24-day hospitalization, she was discharged from our hospital with continuing wound care management. Conservative treatment of closed stable fractures of the pelvic bone along with bed rest is suggested by most orthopedists. However, surgical drainage of hematoma is necessary due to the poor hematoma absorption owing to pelvic fracture. The patient subsequently contracted acute osteomyelitis, a secondary infection associated with the etiology of Fournier's gangrene, particularly in the case of patients with diabetes mellitus. We concluded that this was a rare etiology of Fournier's gangrene and examined the complications of pelvic bone fracture in this context.