Systemic findings include fever, tachycardia, dehydration, leukocytosis, thrombocytopenia, anemia, and hypocalcemia. Children often appear nontoxic and healthy despite advanced infection and pyrexia. All patients with fever or suspected sepsis require a thorough genitalia examination to identify potential perineal sources of infection. The differential diagnosis of a swollen, painful scrotum includes testicular torsion, testicular fracture, and hematoma. A rare cause of a swollen, painful scrotum is extension of subcutaneous emphysema from pulmonary barotrauma or pneumothorax.13 The differential diagnosis in children includes cellulitis, balanitis, orchitis, epididymitis, torsion, hydrocele, strangulated hernia, benign scrotal edema, and various skin diseases.
Plain radiographs can show subcutaneous air.
Escherichia coli is the predominant aerobe while bacteroides is the predominant anaerobe. Other pathogens include proteus, enterococcus, anaerobic streptococci, and clostridium. FG is a true surgical emergency that is rapidly progressive and potentially lethal. Once FG is recognized, the emergency physician should prepare the patient for urgent surgical intervention with aggressive resuscitation and high dose parenteral antibiotics. Immediate urological consultation for debridement is required.