Perforated colonic carcinoma presenting as epididymo-orchitis and Fournier's gangrene

Epididymo-orchitis is a relatively common diagnosis in elderly men, often related to prostatic outflow obstruction. A 70-year-old man presented with a 4-day history of swelling and pain in the scrotum, fevers, dysuria and frequency. He had severe symptoms of prostatic hypertrophy. Physical examination and urine microscopy confirmed the diagnosis of left epididymo-orchitis and antimicrobial therapy was commenced. Subsequently, however, he developed severe necrotizing fasciitis (Fournier's gangrene) of the scrotum requiring surgical debridement, and at laparotomy, a perforated carcinoma of the sigmoid colon was found at the level of the left deep inguinal ring. Despite further radical surgery the gangrene extended, his condition deteriorated and he died. There has been no other similar case reported in the literature, and thus, although rare, intra-peritoneal causes of infection should be considered in patients with Fournier's gangrene.