Fig. 14

The same patient as in Fig. 13b. Fournier gangrene in a 67-year-old diabetic man, with extensive arteriosclerosis, already submitted to aortic bifemoral bypass years ago, still permeable (red circles – patent common femoral bypass grafts located anteriorly to native arteries, occluded on the left). Contrast-enhanced CT scan at level of acetabular dome shows endopelvic fascia and extraperitoneal pelvic spaces. Endopelvic fascia and its two layers are illustrated. The parietal layer covers the elevator muscle of anus and coccygeus (pelvic diaphragm) and the intrapelvic portions of the internal obturator and the piriformis muscles. The visceral layer covers inferior segments of the urinary bladder, lower third of the ureters, uterus, vagina and seminal vesicles; it forms a continuous line enveloping the perirectal fat, the mesorectal fascia. Pelvic spaces. Prevesical space is bordered by transversalis fascia anteriorly and umbilicovesical fascia posteriorly. Paravesical and presacral spaces are limited by parietal and visceral sleeves of the endopelvic fascia. Perivesical space is surrounded by umbilicovesical fascia and rectovesical septum. Perirectal space is involved by the rectal fascia and separated from the perivesical space by the rectovesical septum