Published: 2022-02-28

Acute necrotizing pancreatitis complicating as Fournier’s gangrene

Gautam Anand, Ashutosh Nagpal, Deborshi Sharma


Scrotal involvement is extremely rare complication of acute necrotising pancreatitis. It presents as scrotal swelling and skin color change, which mimics the presentations of testicular torsion, epididymitis, and testicular tumor. Early diagnosis can significantly reduce the associated mortality both with necrotising pancreatitis and Fournier gangrene. Thorough clinical examination along with abdominopelvic Computed Tomography provides a useful means of diagnosing this complication. Here, we are presenting a case of acute necrotising pancreatitis with collection in left pararenal space tracking all the way to reach the left inguinal canal till the root of scrotum, being managed successfully after early diagnosis with early debridement and application of vacuum assisted drainage.


Rare complication of pancreatitis, Acute necrotising pancreatitis, Fournier’s Gangrene, Radiology in acute pancreatitis, Vacuum assisted drainage

Full Text:



Kaistha S, Kumar A, Ramakrishnan TS. Necrotizing fasciitis: a rare complication of acute necrotizing pancreatitis. J Clin Diagn Res 2017;11:D05-6.

Baron TH, Morgan DE. Acute necrotizing pancreatitis. N Engl J Med. 1999;340(18):1412-7.

Radcliffe RS, Khan MA. Mortality associated with Fournier’s gangrene remains unchanged over 25 years. BJU Int. 2020;125(4):610-6.

Krishnamurthy G, Radhakrishna P, Khanna A, Damodaran K. Fournier’s gangrene complicating severe acute pancreatitis: a case report and literature review. J Pancreatol. 2021;4:130-33.

Sheehy SA, Kelly ME, Francis EC, Sweeney KJ, Hussey A. A rare case of Fournier's Gangrene. J Surg Case Rep. 2016;2016(5):rjw069.

Zimin AF, Satsukevich VN, Molchanov NP. Acute pancreatitis with hemorrhagic flow into the scrotum. Vestn Khir Im I I Grek. 1979;122(3):47-8.

White NR, Fowler LL. Retroperitoneal and cutaneous necrotizing fasciitis secondary to necrotizing pancreatitis. J Emerg Med. 2014;47(2):147-9.

Sutalo N, Dragisic V, Miskovic J, Soljic M. Scrotal abscess as the first symptom of fatal necrotizing pancreatitis. Saudi Med J. 2019;40(11):1167-70.

Kim SB, Je BK, Lee SH, Cha SH. Scrotal swelling caused by acute necrotizing pancreatitis: CT diagnosis. Abdom Imaging. 2011;36(2):218-21.

Auerbach J, Bornstein K, Ramzy M, Cabrera J, Montrief T, Long B. Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives. Open Access Emerg Med. 2020;12:353-64.

El-Qushayri AE, Khalaf KM, Dahy A, et al. Fournier’s gangrene mortality: a 17-year systematic review and meta-analysis. Int J Infect Dis. 2020;92:218-25.

Kumar S, O'Donnell ME, Khan K, Dunne G, Carey PD, Lee J. Successful treatment of perineal necrotising fasciitis and associated pubic bone osteomyelitis with the vacuum assisted closure system. World J Surg Oncol. 2008;6:67.

Hajifathalian K, Tafesh ZH, Dawod Q, Saumoy M, Krisko T, Carr-Locke D et al. Use of a vacuum sponge to expedite healing of a large peripancreatic collection. Endoscopy. 2020;52(1):E1-2.