S3446 Fournier Gangrene of the Scrotum as a Rare Complication of Necrotizing Pancreatitis

Introduction: Necrotizing pancreatitis (NP) occurs in approximately 15–20% of hospitalized patients with acute pancreatitis and carries a mortality rate of up to 30%. Complications include infected walled-off collections and multi-organ failure. Fournier’s gangrene (FG), a necrotizing infection of the perineum and scrotum, is an exceedingly rare manifestation of retroperitoneal necrosis extending into the inguinal region. We present a case of FG secondary to NP, highlighting the need for prompt diagnosis and multidisciplinary care to improve outcomes. Case Description/Methods: A 45-year-old man with recurrent alcohol-induced pancreatitis and chronic alcohol use presented with acute epigastric pain. Labs showed a lipase level of 4,000 U/L, and computed tomography confirmed acute pancreatitis. He was managed conservatively and discharged. Seven days later, he was readmitted with worsening pain, and computed tomography revealed necrotizing pancreatitis with a large peripancreatic fluid collection. His course was complicated by volume overload and scrotal swelling, requiring diuretics. After stabilization, he was discharged on a regular diet. Twenty-6 days after the initial presentation, he returned with new scrotal pain, swelling, erythema, necrosis, and clear drainage. Computed tomography showed an 8 × 20 × 22 cm walled-off necrotic collection in the lesser sac extending into the scrotum via the left inguinal canal. Emergent debridement by urology and percutaneous drainage by interventional radiology were performed. Postoperatively, he required intensive care unit care with inotropes and antibiotics, later stabilizing and transitioning to the floor with VAC-assisted wound care. However, 25 days into hospitalization, he developed hypoxic respiratory failure and septic shock, requiring intubation and vasopressors. Despite resuscitation efforts, he progressed to multiorgan failure and died within 24 hours of intensive care unit readmission. Discussion: FG secondary to NP is an exceptionally rare and life-threatening condition. This case underscores the importance of recognizing atypical presentations of NP and the critical role of early, aggressive, multidisciplinary intervention in optimizing outcomes.