Rare Complication of Fournie’s gangrene following Alcohol Sclerotherapy for Hydrocele: A Case Report

Abstract

We present a rare case of an 80-year-old male with a longstanding, asymptomatic right hydrocele seeking repair. Hydrocele, characterized by an abnormal accumulation of serous fluid between the parietal and visceral layers of the tunica vaginalis, is a common condition affecting adult males. While surgical removal remains the gold standard treatment, alternative non-invasive approaches such as sclerotherapy have been explored due to their reported high success rates ranging from 85% to 96%. In this case, the patient underwent a combination of aspiration (340 mL of fluid) and sclerotherapy using 60 mL of absolute alcohol as the sclerosing agent. Following the sclerotherapy procedure, the patient experienced the development of a scrotal wound within 72 hours, which progressed to a necrotic point with associated hyperemia at 96 hours. Subsequently, the patient presented with an unusual necrosis in the scrotal sac, rapidly progressing to Fournier’s gangrene, requiring surgical debridement three surgical debridements seven days post-procedure, followed by antibiotic therapy and 35 hyperbaric sessions. Remarkably, the patient’s condition progressed painlessly, and complete closure of the necrotic lesion was achieved. However, this case underscores the importance of cautious evaluation when considering alcohol sclerotherapy in elderly patients, despite its minimally invasive nature. It serves as a reminder of the potential complications that can arise from non-surgical approaches for hydrocele management and highlights the need for careful patient selection and follow-up in such cases.