article · Scholars Journal of Medical Case Reports
A 68-year-old man presented with severe sepsis and clinical features of Fournier's gangrene after being lost to medical follow-up for one year without exchanging his indwelling suprapubic catheter. Examination revealed perineal and scrotal pain, inflammatory oedema, focal skin necrosis, and complete catheter obstruction caused by extensive calcification of the intravesical balloon. Emergency intervention included haemodynamic resuscitation, broad-spectrum antibiotic therapy, surgical debridement, removal of the calcified device, and placement of a new suprapubic cystostomy. Clinicians reconstructed the scrotum using remaining viable tissue to ensure testicular coverage, whilst postponing the repair of a pre-existing urethro-scrotal fistula until the infection cleared. The case highlights that neglected catheter care can cause severe encrustation, infected urinary stasis, and lethal necrotising infections, emphasising the need for regular catheter maintenance and rapid multidisciplinary care.
Fournier's gangrene is an aggressive, life-threatening soft-tissue infection that requires urgent intervention. This case illustrates how lapses in basic outpatient care, such as scheduled catheter exchanges, can lead to severe medical crises. Establishing reliable clinical follow-up protocols protects long-term catheter users from avoidable encrustation, invasive reconstructive surgeries, and fatal systemic infections.
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Background: Fournier's gangrene is a life-threatening necrotizing fasciitis of the perineal and genital regions that requires urgent recognition and aggressive surgical management. Although several genitourinary sources have been described, Fournier's gangrene caused by neglected suprapubic catheter calcification remains uncommon. Case presentation: A 68-year-old man with a history of urethro-scrotal fistula and suprapubic cystostomy presented to the emergency department with severe sepsis and clinical features consistent with Fournier's gangrene. He had been lost to follow-up for one year, during which the catheter had not been exchanged. Examination revealed perineal and scrotal pain, inflammatory edema, and focal skin necrosis. The suprapubic catheter was non-functional because of complete obstruction related to extensive calcification of the intravesical balloon. Emergency management included hemodynamic resuscitation, broad-spectrum antibiotic therapy, extensive surgical debridement, removal of the calcified catheter, and placement of a new suprapubic cystostomy. Because scrotal skin loss was limited, the scrotum was reconstructed using the remaining viable scrotal tissue, allowing adequate testicular coverage. Definitive repair of the urethro-scrotal fistula was deferred until complete resolution of infection. Conclusion: This case highlights the importance of structured urological follow-up and routine catheter replacement in patients with long-term indwelling catheters. Catheter encrustation and balloon calcification may result in obstruction, infected urinary stasis, and life-threatening complications such as Fournier's gangrene. Prompt multidisciplinary management, including resuscitation, broad-spectrum antibiotics, aggressive debridement, appropriate urinary diversion, and staged reconstruction, is essential for favorable outcomes.
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DOI: 10.36347/sjmcr.2026.v14i08.028
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