A 77-year-old man with the history of alcoholic hepatic insufficiency, diabetes and hypertension was admitted to the hospital because of appetite loss and abdominal pain. The patient went into shock a day after admission, then the erosion of his scrotum was found. He was diagnosed as Fournier's gangrene and had emergency debridement of necrotic tissue. The necrosis extended to scrotum, perineum, anal sphincter, levator muscle, and lower part of rectum. He recovered from shock after endotoxin removal. To prevent contamination by stools due to deterioration of anal function, we made a permanent colostomy on thirteenth day after the first operation. The patient was discharged 23 weeks and 3 days after the first operation as the wound had almost healed. Fournier's gangrene is a necrotizing fasciitis of the perineal and genital legion. It spreads rapidly and mortality rate is still high. The most common underlying disorders are diabetes and alcoholism. Thus possibility of Fournier's gangrene should be considered in patients who have such disorders. The choice of treatment in Fournier's gangrene is debridement of necrotic tissue in early stage. Additionally it may be an effective treatment to remove endotoxin by apheresis.