A 55-year-old diabetic male presents with a hot, swollen, erythematous scrotum developing over 24 hours with crepitus on palpation. He appears septic with HR 118 and temperature 38.9°C. The MOST appropriate immediate management is:

• A Urgent surgical debridement with wide excision of all necrotic tissue (Fournier's gangrene protocol), combined with broad-spectrum antibiotics and ICU support ✓
• B Broad-spectrum IV antibiotics alone for 48 hours and reassessment
• C CT scan to define the extent of infection before surgery
• D Incision and drainage under local anaesthesia

Explanation

Fournier's gangrene is a life-threatening polymicrobial necrotising fasciitis of the perineum and external genitalia. The pathognomonic crepitus indicates gas-producing organisms (clostridial and non-clostridial anaerobes). Mortality is 20–40% and increases with delay. The cornerstone of treatment is urgent extensive surgical debridement of all necrotic tissue until bleeding healthy tissue is reached, combined with broad-spectrum antibiotics (covering gram-positive, gram-negative, and anaerobic organisms) and ICU-level supportive care. CT may support diagnosis when uncertain but must NEVER delay surgery in a septic patient with crepitus. Antibiotics alone without debridement carry near-100% mortality.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.