A case is presented of a healthy young man who had Fournier's gangrene after standard bilateral vasectomy. Despite maximal treatment, including extensive necrectomy and broad-spectrum antibiotics, this complication was lethal. To our knowledge a lethal complication of vasectomy has not been reported in the literature.
PIP: A health practitioner performed a standard bilateral vasectomy on a 33-year old male who did not suffer from an immunodepressed state. No complications arose and bleeding was minimal during the vasectomy. 2 days later, he visited a physician with a fever of 39 degrees Celsius and wound reaction. The physician prescribed oral floxacillin, but the following day he suffered acute septic shock and was admitted to a hospital. The incision site was red due to congestion of capillaries, purple, swollen, and painful. Physicians ruled out prostatitis, abscess formation, and a pulmonary source as causes of the fever. The white blood cell count, potassium, creatinine, and glucose levels were very high. Physicians administered parenteral broad spectrum antibiotic treatment (imipenem/cilastatine and metronidazole) even though the blood, urine, and sputum cultures grew no pathogens. They found and evacuated hematoma and necrotic tissue from the vasectomy sites. They placed silicone drains in the sites. Within the next 24 hours, necrosis developed in the scrotum while his clinical condition declined rapidly. He suffered a cardiac arrest. They transported him to the University Hospital in Leiden, the Netherlands where physicians did a necrotomy of the scrotal, penile, and perineal skin and removed both testes. 100 colonies of Streptococcus hemolytic group A, 10-100 colonies of Escherichia coli, and 10 colonies of Staphylococcus epidermidis grew in the cultures of tissue removed at the other hospital. Yet cultures from tissue removed at the University Hospital were negative. No anaerobic bacteria colonies grew. The physicians administered penicillin, ceftazidime, and floxacillin based on antibiotic sensitivity testing results. They also began hemodialysis. 24 hours after necrotomy and bilateral orchiectomy, the necrotizing process had not spread. Yet 13 hours later and 5 days after the vasectomy, the patient succumbed. This case was the 1st known fatal complication of vasectomy. The diagnosis was scrotal gangrene of Fournier.