Fournier's Gangrene Following Hydrogel Spacer-related Rectal Ulcer and Fistula in a Patient Undergoing Radiation Therapy for Prostate Cancer.

Hydrogel spacers are commonly used to reduce rectal toxicity during radiation therapy for prostate cancer. Although generally safe, rare, serious complications may occur. We report the case of a man with diabetes and renal failure who developed a refractory rectal ulcer and fistula five months after spacer placement, followed by Fournier's gangrene. The patient recovered following surgical drainage and antibiotic therapy. This is the first reported case of Fournier's gangrene following hydrogel spacer insertion. Spacer-related rectal wall infiltration might have contributed to this finding. Clinicians should recognize such adverse events and consider early intervention in high-risk patients presenting with hematochezia or perineal symptoms.