Case reportA 40-years-old man presented to the emergency depart-ment (ED) with edema and pain of the scrotal and perinealregion. The patient’s symptoms began 10 day prior. Noconcomitant diseases were present. There were no drugallergies. The patient had intermittent problems withhemorrhoids for 10 years. On physical examination, thepatient was responsive and alert. The blood pressure was100/60 mmHg, the pulse was 72/min. Perineal examinationrevealed the entire perineal skin to be gangrenous andnecrotic and very malodorous (Fig. 1). The leukocytecount was 21,000 mm