Fournier's gangrene: two unusual cases.

Case 1. A 60year old man was admitted with symptoms and signs of a perforated duodenal ulcer. At operation a perforated duodenal ulcer with widespread peritoneal contamination was found. The ulcer was oversewn and covered with an omental patch. A tube drain was placed in the subhepatic space and exteriorized in the right hypochondrium. On the fifth postoperative day he developed cellulitis around the abdominal drain site and gross swelling of his penis and scrotum with gangrene of the right sided scrotal skin. A fistula from the first part of the duodenum to the drain site and a further tract from the drain site, via the subcutaneous tissue, to the scrotum, was demonstrated by upper gastro intestinal contrast studies. Culture of the necrotic scrotal skin revealed infection with Pseudomonas aeruginosa, Streptococcus faecalis and Escherichia coli.