Fournier's gangrene in childhood: a report of 3 infant patients Gülsen Ekingen a , Tonguç Isken b , Hakan Agir b , Selim Öncel c, ⁎ , Ayla Günlemez d a Department of Pediatric Surgery, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, Turkey b Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, Turkey c Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, Turkey d Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Kocaeli University, 41380 Kocaeli, Turkey Received 27 March 2008; revised 13 August 2008; accepted 16 September 2008 Key words: Fournier's gangrene; Perianal necrosis; Children; Colostomy Abstract Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy.Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively. Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene. © 2008 Elsevier Inc. All rights reserved. Fournier's gangrene (FG) is an uncommon necrotizing fasciitis of genitalia and perineum that has high mortality and morbidity [1]. Although initially attributed to Baurienne (1764), FG is named after Jean-Alfred Fournier, who, in 1883 described the entity as idiopathic gangrene of sudden onset and rapid development at the level of genitalia, presenting mainly in healthy young males [1-3]. Now, it is well known that this entity is not solely seen in young males in several reports; the age range changed from early infancy up to adulthood [1,4,5]. Fournier's gangrene has been reported in children in the first week of life. It remains relatively uncommon in children, with just 56 cases reported to date in the literature although Legbo et al. [5] concluded that NF was more common in children than adults in their country [6]. In cases originating in the genitalia, the infecting bacteria probably pass through Buck's fascia of the penis and spread along the dartos fascia of the scrotum and penis, Colles' fascia of the perineum, and Scarpa's fascia of the anterior abdominal wall [1,3,6]. The 3 findings characterizing the syndrome are abrupt onset, rapid progression, and absence of a specific etiologic agent. In early stages, involved area is swollen, erythematous, and tender. As infection begins to involve the deep fascia, pain becomes prominent with high fever and systemic toxicity. The swelling and crepitus of the scrotum progresses, and dark purple areas develop resulting in extensive scrotal gangrene [1,3]. Predisposing factors include diabetes mellitus, local trauma, paraphimosis, periurethral extravasation of urine, perirectal or perianal infections, and surgery, such as circumcision or hernior- rhaphy [1,3,7]. Fournier's gangrene is a rare infectious entity ⁎ Corresponding author. Cocuk Sagligi ve Hastaliklari Anabilim Dali, Kocaeli Universitesi Tip Fakultesi, Umuttepe Yerleskesi, Izmit, 41380 Kocaeli, Turkey. E-mail address: SelimOncel@doctor.com (S. Öncel). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2008.09.014 Journal of Pediatric Surgery (2008) 43, E39–E42