The Lord of the Rings — Fournier’s Gangrene as a Consequence of Strangulating Testicular Rings

  • N. Zantl
  • R. Hartung


Fournier’s gangrene is a rare but life-threatening, special form of dermal necrosis located in the genitourinary region. Mortality rates range from 4% to 43% in actual series (Dahm et al. 2000; Mindrup et al. 2005; Yeniyol et al. 2004; Korkut et al. 2003; Burdal et al. 2003; Chawla et al. 2003; Asci et al. 1998; Nisbet and Tompson 2002; Corman et al. 1999; Korhonen et al. 1998; Hollabaugh et al. 1998; Benizri et al. 1996; Palmer et al. 1995). The main treatment principle is an immediate, extensive debridement of the entire necrotic tissue under concurrent broad-spectrum antibiotic therapy. Reconstruction can be performed only when the wound is free from infection. In this chapter, we report a case of Fournier’s gangrene caused by the deterioration of the blood supply caused by scrotal rings and discuss etiology, symptoms, and treatment of Fournier’s gangrene.


Hyperbaric Oxygen Necrotizing Fasciitis Pyoderma Gangrenosum Polyarteritis Nodosa Scrotal Skin 
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  1. Amendola MA, Casillas J, Joseph R et al (1994) Fournier’s gangrene: CT findings. Abdom Imaging 19:471PubMedCrossRefGoogle Scholar
  2. Anaya DA, McMahon K, Nathens AB et al (2005) Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg 140:151; discussion 158PubMedCrossRefGoogle Scholar
  3. Asci R, Sarikaya S, Buyukalpelli R et al (1998) Fournier’s gangrene: risk assessment and enzymatic debridement with lyophilized collagenase application. Eur Urol 34:411PubMedCrossRefGoogle Scholar
  4. Baurienne H (1764) Sur une plaie contuse qui s’est terminée par le sphacèle du scrotum. J Med Chir Pharm 20:25Google Scholar
  5. Benizri E, Fabiani P, Migliori G et al (1996) Gangrene of the perineum. Urology 47:935PubMedCrossRefGoogle Scholar
  6. Chawla SN, Gallop C, Mydlo JH (2003) Fournier’s gangrene: an analysis of repeated surgical debridement. Eur Urol 43:572PubMedCrossRefGoogle Scholar
  7. Corman JM, Moody JA, Aronson WJ (1999) Fournier’s gangrene in a modern surgical setting: improved survival with aggressive management. BJU Int 84:85PubMedCrossRefGoogle Scholar
  8. Dahm P, Roland FH, Vaslef SN et al (2000) Outcome analysis in patients with primary necrotizing fasciitis of the male genitalia. Urology 56:31; discussion 35PubMedCrossRefGoogle Scholar
  9. Downing R, Black J (1985) Polyarteritis nodosa: an unrecognized cause of Fournier’s gangrene. Br J Urol 57:355PubMedCrossRefGoogle Scholar
  10. Eke N (2000) Fournier’s gangrene: a review of 1726 cases. Br J Surg 87:718PubMedCrossRefGoogle Scholar
  11. Elliott D, Kufera JA, Myers RA (2000) The microbiology of necrotizing soft tissue infections. Am J Surg 179:361PubMedCrossRefGoogle Scholar
  12. Endorf FW, Supple KG, Gamelli RL (2005) The evolving characteristics and care of necrotizing soft-tissue infections. Burns 31:269PubMedCrossRefGoogle Scholar
  13. Farrell AM, Black MM, Bracka A et al (1998) Pyoderma gangrenosum of the penis. Br J Dermatol 138:337PubMedCrossRefGoogle Scholar
  14. Fournier JA (1883) Gangrène foudroyante de la verge. Medecin Practique 4:589Google Scholar
  15. Gurdal M, Yucebas E, Tekin A et al (2003) Predisposing factors and treatment outcome in Fournier’s gangrene. Analysis of 28 cases. Urol Int 70:286PubMedCrossRefGoogle Scholar
  16. Hollabaugh RS Jr, Dmochowski RR, Hickerson WL et al (1998) Fournier’s gangrene: therapeutic impact of hyperbaric oxygen. Plast Reconstr Surg 101:94PubMedCrossRefGoogle Scholar
  17. Korhonen K, Hirn M, Niinikoski J (1998) Hyperbaric oxygen in the treatment of Fournier’s gangrene. Eur J Surg 164:251PubMedCrossRefGoogle Scholar
  18. Korkut M, Icoz G, Dayangac M et al (2003) Outcome analysis in patients with Fournier’s gangrene: report of 45 cases. Dis Colon Rectum 46:649PubMedCrossRefGoogle Scholar
  19. McHenry CR, Piotrowski JJ, Petrinic D et al (1995) Determinants of mortality for necrotizing soft-tissue infections. Ann Surg 221:558; discussion 563PubMedCrossRefGoogle Scholar
  20. Mindrup SR, Kealey GP, Fallon B (2005) Hyperbaric oxygen for the treatment of Fournier’s gangrene. J Urol 173:1975PubMedCrossRefGoogle Scholar
  21. Nisbet AA, Thompson IM (2002) Impact of diabetes mellitus on the presentation and outcomes of Fournier’s gangrene. Urology 60:775PubMedCrossRefGoogle Scholar
  22. Okizuka H, Sugimura K, Yoshizako T (1992) Fournier’s gangrene: diagnosis based on MR findings. AJR Am J Roentgenol 158:1173PubMedGoogle Scholar
  23. Palmer LS, Winter HI, Tolia BM et al (1995) The limited impact of involved surface area and surgical debridement on survival in Fournier’s gangrene. Br J Urol 76:208PubMedGoogle Scholar
  24. Schultz ES, Diepgen TL, von den Driesch P et al (1995) Systemic corticosteroids are important in the treatment of Fournier’s gangrene: a case report. Br J Dermatol 133:633PubMedCrossRefGoogle Scholar
  25. Shupak A, Shoshani O, Goldenberg I et al (1995) Necrotizing fasciitis: an indication for hyperbaric oxygenation therapy? Surgery 118:873PubMedCrossRefGoogle Scholar
  26. Smith GL, Bunker CB, Dinneen MD (1998) Fournier’s gangrene. Br J Urol 81:347PubMedGoogle Scholar
  27. Sohn M, Kistler D, Kindler J et al (1989) Fournier’s gangrene in hypersensitivity vasculitis. J Urol 142:823PubMedGoogle Scholar
  28. Stephens BJ, Lathrop JC, Rice WT et al (1993) Fournier’s gangrene: historic (1764) versus contemporary (1979) differences in etiology and clinical importance. Am Surg 59:149PubMedGoogle Scholar
  29. Wilkinson D, Doolette D (2004) Hyperbaric oxygen treatment and survival from necrotizing soft tissue infection. Arch Surg 139:1339PubMedCrossRefGoogle Scholar
  30. Yeniyol CO, Suelozgen T, Arslan M et al (2004) Fournier’s gangrene: experience with 25 patients and use of Fournier’s gangrene severity index score. Urology 64:218PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2007

Authors and Affiliations

  • N. Zantl
    • 1
  • R. Hartung
    • 1
  1. 1.Urologische Klinik und PoliklinikTechnische Universität MünchenMunichGermany

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