A 60-year-old diabetic man develops rapidly spreading scrotal and perineal pain with fever. Examination shows dusky skin, foul-smelling oedematous tissue and crepitus over the scrotum. Crepitus indicates:

• A Subcutaneous fat necrosis
• B Gas produced by mixed aerobic and anaobic organisms ✓
• C Underlying inguinal hernia
• D Necrosis limited to the dartos muscle

Explanation

This is Fournier gangrene, a necrotising fasciitis of the perineum. Palpable crepitus results from gas formation by the causative mixed flora, typically coliforms such as E. coli, anaobes including Bacteroides and Clostridium species, and streptococci. Diabetes mellitus is the classic predisposing factor. Management requires aggressive resuscitation, broad-spectrum antibiotics and immediate radical debridement of all necrotic tissue; hyperbaric oxygen is adjunctive. Delaying surgery for imaging or antibiotics alone carries high mortality.

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.