A 62-year-old diabetic man presents with rapidly progressive scrotal and perineal pain, swelling, and foul smelling discharge of 3 days duration. Examination shows dusky scrotal skin with palpable crepitus and patchy necrosis. He is febrile and tachycardic. After resuscitation and blood cultures, what is the immediate next step in management?

• A Simple incision and drainage of the scrotal collection
• B Broad spectrum antibiotics alone until demarcation of necrosis occurs
• C Aggressive surgical debridement combined with broad spectrum antibiotics ✓
• D Hyperbaric oxygen therapy before any surgical intervention

Explanation

Fournier gangrene is a polymicrobial necrotising fasciitis of the perineum, commonly involving coliforms, anaerobes, and streptococci, and carrying high mortality in diabetics. Crepitus signals gas forming infection requiring urgent radical debridement of all necrotic tissue together with broad spectrum antibiotic coverage. Antibiotics alone or simple drainage fail to remove the nidus and allow rapid spread. Hyperbaric oxygen is an adjunct in selected cases and must never delay surgery.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.