Kareem Rifai1, Ahmad Oussama Rifai2*, Sidra Shakil1, Mohammad Mehio4, Sami M Rifai3 and Sarah Rifai3
1Alabama College of Osteopathic Medicine, USA
2The Virtual Nephrologist Inc, USA
3Hypertension Kidney and Dialysis Specialists, USA
4University of South Florida Internal Medicine Residency Program, USA
A 47-year-old man presented with an erythematous, edematous, and tender scrotum occurred after prolonged car driving. The patient had a history of end-stage renal disease and was being treated with Peritoneal Dialysis (PD) for 3 years. After admission with an initial diagnosis of scrotal cellulitis, pelvic non-contrast computed tomography revealed a right-sided hydrocele and a small left-sided inguinal hernia. After he became slightly febrile and the swelling and tenderness spread into the perineum, follow-up computed tomography could not rule out an abscess. Fournier’s gangrene was suspected and surgical debridement was planned. Computed tomography peritoneography with a non-ionic contrast solution in the dialysate confirmed a dialysate leak into the scrotum and perineum. The PD was discontinued, and hemodialysis initiated. All antibiotics were discontinued. The symptoms resolved within 24 h. This unique presentation of minimal scrotal and extensive perineal edema and pain prompted the misdiagnosis of Fournier’s gangrene for its surgical emergency.
Rifai K, Rifai AO, Shakil S, Mehio M, Rifai SM, Rifai S. Peritoneal Dialysate Leak Mistaken as Fournier's Gangrene. Clin Surg. 2021; 6: 3364..