A rare case of retroperitoneal extension in Fournier's gangrene: A case report and review of literature.

Introduction and importance: Retroperitoneal extension is a rare and fatal complication of Fournier's gangrene (FG) which mandates immediate surgical intervention for better outcome. Case presentation: A 70-year-old male presented to the emergency department with a history of bilateral painful scrotal swelling for 7 days with fever and abdominal pain for 3 days. On his general examination, he was septic with necrotic patches in the perineum and bilateral scrotum. Imaging revealed soft tissue gas and collections in scrotum extending to the right retroperitoneum with massive collection suggestive of retroperitoneal abscess. Following resuscitation and intravenous antibiotics, immediate exploratory laparotomy was done to drain the retroperitoneal abscess followed by debridement of Fournier's gangrene. The patient remained well on follow up. Clinical discussion: Fournier gangrene is a fulminant polymicrobial infection of the perineum, scrotum and penis which when complicated by retroperitoneal extension, has a very high mortality. Majority of patients have an immunocompromised condition. Early diagnosis with prompt surgical drainage and debridement (within 6 hours) significantly reduces the mortality. Conclusion: High index of suspicion, careful clinical examination and timely use of imaging is crucial for early diagnosis of this rare but fatal complication of FG. Furthermore, adequate resuscitation with prompt surgical intervention is the key for a favorable outcome.