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Fournier's gangrene. First described in the literature in 1883, necrotizing fasciitis of the perineum (Fournier's gangrene) is an infection of the deep subcutaneous tissue, resulting in extensive damage to fat and fascia while oftentimes sparing the skin.1Laor E. Palmer L.S. Tolia B.M. et al.Outcome prediction in patients with Fournier's gangrene.J Urol. 1995; 154: 89-92Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar, 2Atakan I.H. Kaplan M. Kaya E. et al.A life-threatening infection: Fournier's gangrene.Int Urol Nephrol. 2002; 34: 387-392Crossref PubMed Scopus (42) Google Scholar There can be a rapid progression from a seemingly minor infection to extensive tissue destruction with associated systemic symptoms, including sepsis and death. Rapidly increasing severe pain is often the first symptom but may be absent in diabetics as a result of neuropathy. In men, it most commonly affects the scrotum. It is usually a result of perineal trauma or diabetes, with the most common organisms being mixed aerobic and anaerobic bacteria.3Norton K. Johnson L. et al.Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment.Am Surg. 2002; 68: 709-714PubMed Google Scholar, 4Kilic A. Aksoy Y. Kilic L. Fournier's gangrene: etiology, treatment, and complications.Ann Plast Surg. 2001; 47: 523-527Crossref PubMed Scopus (47) Google Scholar Definitive treatment is surgical debridement in conjunction with parenteral antibiotics and supportive care. Mortality ranges from 11% to 65%.2Atakan I.H. Kaplan M. Kaya E. et al.A life-threatening infection: Fournier's gangrene.Int Urol Nephrol. 2002; 34: 387-392Crossref PubMed Scopus (42) Google Scholar, 3Norton K. Johnson L. et al.Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment.Am Surg. 2002; 68: 709-714PubMed Google Scholar, 4Kilic A. Aksoy Y. Kilic L. Fournier's gangrene: etiology, treatment, and complications.Ann Plast Surg. 2001; 47: 523-527Crossref PubMed Scopus (47) Google Scholar Fournier's gangrene. First described in the literature in 1883, necrotizing fasciitis of the perineum (Fournier's gangrene) is an infection of the deep subcutaneous tissue, resulting in extensive damage to fat and fascia while oftentimes sparing the skin.1Laor E. Palmer L.S. Tolia B.M. et al.Outcome prediction in patients with Fournier's gangrene.J Urol. 1995; 154: 89-92Abstract Full Text Full Text PDF PubMed Scopus (309) Google Scholar, 2Atakan I.H. Kaplan M. Kaya E. et al.A life-threatening infection: Fournier's gangrene.Int Urol Nephrol. 2002; 34: 387-392Crossref PubMed Scopus (42) Google Scholar There can be a rapid progression from a seemingly minor infection to extensive tissue destruction with associated systemic symptoms, including sepsis and death. Rapidly increasing severe pain is often the first symptom but may be absent in diabetics as a result of neuropathy. In men, it most commonly affects the scrotum. It is usually a result of perineal trauma or diabetes, with the most common organisms being mixed aerobic and anaerobic bacteria.3Norton K. Johnson L. et al.Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment.Am Surg. 2002; 68: 709-714PubMed Google Scholar, 4Kilic A. Aksoy Y. Kilic L. Fournier's gangrene: etiology, treatment, and complications.Ann Plast Surg. 2001; 47: 523-527Crossref PubMed Scopus (47) Google Scholar Definitive treatment is surgical debridement in conjunction with parenteral antibiotics and supportive care. Mortality ranges from 11% to 65%.2Atakan I.H. Kaplan M. Kaya E. et al.A life-threatening infection: Fournier's gangrene.Int Urol Nephrol. 2002; 34: 387-392Crossref PubMed Scopus (42) Google Scholar, 3Norton K. Johnson L. et al.Management of Fournier's gangrene: an eleven year retrospective analysis of early recognition, diagnosis, and treatment.Am Surg. 2002; 68: 709-714PubMed Google Scholar, 4Kilic A. Aksoy Y. Kilic L. Fournier's gangrene: etiology, treatment, and complications.Ann Plast Surg. 2001; 47: 523-527Crossref PubMed Scopus (47) Google Scholar Images in Emergency MedicineAnnals of Emergency MedicineVol. 47Issue 1PreviewA 49-year-old man presented to the emergency department with complaints of flulike symptoms with scrotal edema and pain. At that time, the patient was admitted to receive intravenous antibiotics. His symptoms progressively worsened throughout the next 5 days, including increased pain, fever, and perineal edema (Figure 1). On computed tomographic scan, he was found to have gas in the soft tissues of his scrotum (Figure 2). He was then transferred to our facility and taken to the operating room. Full-Text PDF