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INFECTION & SEPSIS • SENIOR RESIDENT / SURGEON

Fournier's Gangrene

A rapidly progressive perineal infection demands recognition of necrotizing disease, immediate resuscitation and wide operative debridement.

PROTOTYPE REVIEW REQUIRED
01
The Call

65-year-old man with diabetes, obesity and renal insufficiency

Progressive perineal and scrotal pain followed by fever, hypotension, erythema, edema, skin necrosis and crepitus. CT demonstrates soft-tissue gas.

T 39.4 C • HR 128 • MAP high 50s
Perineal pain plus toxicity and soft-tissue gas is a surgical emergency until proven otherwise.
Read the Image • Clinical DataACS VISUAL
Fournier gangrene clinical image from the ACS image archive.
Fournier gangrene clinical image from the ACS image archive.
Make the Decision • Commit to a Plan

A diabetic patient has severe perineal pain, crepitus and shock. CT confirms extensive gas tracking along fascial planes. Best next step?