# Fournier's Gangrene and Pneumothorax Secondary to Nontraumatic Duodenal Perforation

## TL;DR

A rare case of a 69-year-old man with a perforated duodenal ulcer leading to Fournier's gangrene and pneumothorax is presented, highlighting unusual complications of peptic ulcer disease.

## Contribution

This is the first documented case of simultaneous Fournier's gangrene and pneumothorax resulting from a nontraumatic duodenal ulcer perforation.

## Key findings

- Nontraumatic duodenal ulcer perforation can lead to Fournier's gangrene and pneumothorax.
- Prompt surgical intervention improved outcomes in this rare case.
- Enteric contents may spread through fascial planes to cause distant complications.

## Abstract

Peptic ulcer disease (PUD) results from erosion and ulceration of the upper digestive tract mucosa. Clinical presentations can vary from asymptomatic to severe complications such as perforation, strictures, or bleeding. Perforation can release enteric contents and gas into the abdomen, leading to intra-abdominal sepsis, requiring surgical intervention for source control and repair. We present a case of a 69-year-old male who developed both Fournier's gangrene and a right-sided pneumothorax secondary to a nontraumatic perforated duodenal ulcer. The patient underwent an emergent thoracostomy, laparotomy with Graham omentoplasty, and extensive debridement with successful outcome. While rare complications like pneumothorax and necrotizing soft tissue infections have been documented, their simultaneous occurrence from a nontraumatic ulcer perforation is unprecedented in literature. Previous reports suggest enteric contents can traverse retroperitoneal fascial planes and peritoneal defects to reach distant anatomical sites as a possible mechanism for these complications. This case highlights the potential for atypical presentations of PUD and the importance of comprehensive evaluation, early recognition, and prompt surgical intervention.