A 58-year-old diabetic man presents with rapidly spreading scrotal pain, swelling, foul smelling discharge and palpable crepitus extending to the perineum. He is febrile with tachycardia. Along with resuscitation and broad spectrum antibiotics, the definitive treatment is:

• A Incision and drainage of the scrotal abscess
• B Wide surgical debridement of all necrotic tissue ✓
• C Orchidectomy through a scrotal incision
• D Hyperbaric oxygen alone until sepsis settles

Explanation

This is Fournier gangrene, a necrotising fasciitis that is usually polymicrobial, with Escherichia coli the commonest single organism. The mortality driver is delay, so aggressive resuscitation, broad spectrum antibiotics and urgent radical debridement of all necrotic skin, fascia and subcutaneous tissue are mandatory. Simple incision and drainage is inadequate, the testes are typically spared because their blood supply is intraperitoneal in origin, and hyperbaric oxygen is only an adjunct.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.