A 55-year-old diabetic man presents with high fever, left flank pain, and crepitus in the left perineal region. CT scan shows gas in the subcutaneous tissues and fascial planes of the perineum with patchy necrosis. Which is the most definitive next step in management?

• A Intravenous meropenem alone
• B Percutaneous drainage under CT guidance
• C Hyperbaric oxygen therapy
• D Aggressive surgical debridement of all necrotic tissue ✓

Explanation

Fournier gangrene is a necrotizing fasciitis of the perineum and is a surgical emergency. The definitive treatment is aggressive surgical debridement of all necrotic tissue until viable bleeding tissue is encountered. Antibiotics and supportive care are adjuncts but cannot replace surgery. Delay in debridement increases mortality significantly.

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.