Hyperbaric Oxygen Therapy as an Adjunctive Treatment for Pediatric Fournier’s Gangrene

Fournier's gangrene (FG) is a rapidly progressive necrotizing soft-tissue infection involving the perineal and genital regions.Although predominantly described in adults, it is rare in children and may be associated with substantial morbidity and mortality.Early recognition, prompt broad-spectrum antimicrobial therapy, and urgent surgical debridement remain the cornerstone of treatment.Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment because of its ability to increase tissue oxygenation and potentially promote wound healing in ischemic and infected tissues.However, evidence supporting its use in pediatric FG remains limited.We report the case of a 14-year-old boy with a neurogenic bladder, bilateral ureterohydronephrosis, and chronic kidney disease who developed Fournier's gangrene associated with a chronic urinary catheter and infection with ceftriaxone-resistant Klebsiella pneumoniae (K.pneumoniae).The patient presented with fever and acute scrotal inflammatory changes.Computed tomography demonstrated extensive inflammatory changes of the peripenile and periscrotal soft tissues with multiple intratissue gas foci, consistent with FG.Emergency surgical exploration and extensive debridement were performed, followed by targeted antimicrobial therapy with imipenem and amikacin.HBOT was subsequently administered as an adjunctive treatment, with a total of 10 sessions, in addition to intensive local wound care.Clinical improvement was observed, allowing subsequent surgical revision and closure of the scrotal wound.This case highlights the importance of early recognition and multidisciplinary management of pediatric FG and illustrates the potential role of HBOT as an adjunct to surgical and antimicrobial treatment in selected pediatric patients.