PMC5733135_01
Coronal CT image showing gas tracking from left perirectal area superiorly into the left retroperitoneum to the level of the medial and inferior left kidney.
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A computerized tomography (CT) scan of the abdomen and pelvis revealed significant air, fluid, and inflammation around the rectum and scrotum tracking proximally through the pelvis and into the left retroperitoneum with inflammation just below the left kidney (Figures 1 and 2) which prompted a surgical consultation.
Axial CT image showing gas around the left rectum to the sacrum and ascending anterior along the left internal pelvic sidewall.
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A computerized tomography (CT) scan of the abdomen and pelvis revealed significant air, fluid, and inflammation around the rectum and scrotum tracking proximally through the pelvis and into the left retroperitoneum with inflammation just below the left kidney (Figures 1 and 2) which prompted a surgical consultation.
Photographic image of the necrotic tissue of the scrotum with a Penrose drain inserted after an inadequate debridement.
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The patient underwent emergent debridement of the perineal and scrotal abscesses and was admitted to the American Burn Association- (ABA-) verified burn center (Figure 3).
Photographic image of the perineum and scrotum post debridement of involved skin and subcutaneous tissue and packing at the perineal level extending into the pelvis.
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The patient was repeatedly operated upon every 24 hours for a more extensive perineal and scrotal debridement (Figure 4).
Photographic image of the patient's midline abdominal closure and colostomy bag after left-sided colostomy creation for fecal diversion.
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The anal sphincter complex required complete excision secondary to necrosis which then necessitated a proximal colonic diversion for control of his fecal incontinence (Figure 5).
Photographic image of the patient's reconstruction using 1-to-1 meshed split-thickness skin grafts to the testicles to create a neoscrotum.
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After approximately six weeks convalescing, there was sufficient granulation tissue on the perineum and testicles, and he underwent one-to-one meshed split-thickness skin grafting for cutaneous coverage and creation of a neoscrotum for the testicles (Figure 6).